@article{ref1,
title="Clinical and neurosurgical management of cranial machete injuries: the experience of a tertiary referral center in Nicaragua",
journal="World neurosurgery",
year="2018",
author="Zapata, Luis and Wright, Ernest J. and Nakaji, Peter",
volume="116",
number="",
pages="140-143",
abstract="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. <br><br>METHODS: A retrospective chart review identified patients admitted to a neurosurgery service for cranial machete injury. <br><br>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. <br><br>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.<br><br>Copyright © 2018 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1878-8750",
doi="10.1016/j.wneu.2018.05.020",
url="http://dx.doi.org/10.1016/j.wneu.2018.05.020"
}