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Affiliation
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Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. Electronic address: Neuropub@barrowneuro.org. |
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Abstract
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BACKGROUND: The neurosurgical literature rarely describes managing open head injuries caused by machetes, although this is a common head injury in developing countries. We present our experience managing cranial machete injuries in Nicaragua over a 5-year period.
METHODS: A retrospective chart review identified patients admitted to a neurosurgery service for cranial machete injury.
RESULTS: Among 51 patients studied, the majority (n=42, 82%) presented with mild neurological deficits (Glasgow Coma Scale score ≥14). Non-depressed skull fracture (25/37, 68%) was the most common injury identified on skull radiography and pneumocephalus (15/29, 52%) was the most common injury identified with computed tomography. Overall, 38 patients (75%) underwent surgical intervention for 1 or more conditions, including laceration length ≥10 cm (n=20), open intracranial wound (n=8), pneumocephalus (n=7), cerebral contusion (n=6), intracranial hemorrhage (n=5), and depressed fracture (n=5). All patients received aggressive antibiotic therapy. Patients without intracranial injury received a 7-day course of intravenous ceftriaxone, followed by a 10-day course of oral ciprofloxacin. Patients with violation of the dura received a 7- to 14-day course of intravenous metronidazole, ceftriaxone, and vancomycin, followed by a 10-day course of oral ciprofloxacin. Postoperative complications included a visible skull defect (n=6), infection (n=3), and unspecified neurological (n=2) and mixed (n=1) complications. At discharge, most patients had only minimal disabilities (n=47 [92%]). In-hospital mortality rate was zero.
CONCLUSIONS: An aggressive approach to managing open head injury caused by machete yields good outcomes, with the majority of patients experiencing minimal disability at hospital discharge and a low rate of infection.
Copyright © 2018 Elsevier Inc. All rights reserved.
Language: en |