Risk factors for postoperative infection after combat related head injuries

Abstract

Introduction 
 The prevalence of penetrating head injuries (PBI) has increased during the latest wars making up to 37,4% of all injuries (1,2) Microbiology of modern war wounds is unique for each military conflict depending on the climatic and geographical features of the theater of combat (3,4).
 Material and methods: 
 286 patients were operatively treated after penetrating combat injury in our institution between 1991-1999. Based on the inclusion criteria: combat-related cranial injury and absence of severe abdominal or chest combat injuries, as well as their ability to report for a follow-up exam led to the inclusion of 202 patients. Initial surgical treatment included removal of devitalized soft tissue and bone fragments with craniectomy, removal of devitalized brain tissue, easily accessible intracerebral bone and metal fragments and intracranial hemathoma. All patients received the same standardized postoperative care with triple antibiotics.
 Results
 
 Infection occurred in 36 patients (17,82%). In vast majority of the cases infection occurred in the form of brain abscess 31 (86.11%), in 4 cases as meningitis (11.1%) and in 1 case as osteomyelitis and epidural infection (2.78%). Retained metal and bone fragments and postoperative liquorrhea have significant influences on occurrence of postoperative infection. 
 
 Conclusion
 
 Postoperative infection considerably increases long term functional outcome. Using advantages of minimally invasive surgical technique, neuronavigation or intraoperative imaging for removal of retained foreign bodies can reduce risk for postoperative infection with minimal risk of additional neurologic deficit. Autograft is preferable option for dural reconstruction in combat related head injuries.