The treatment of wartime brain wounds: traditional versus minimal debridement.
BACKGROUND
Since World War II, surgeons in Western armies dealing with brain wounds have generally advocated thorough missile track debridement, and many have urged meticulous dural closure to prevent cerebral spinal fluid (CSF) leakage and subsequent infection. For the last decade some reports have appeared wherein wartime brain wounds have been treated by minimal brain debridement with little or no attention to tight dural closure. This report compares and contrasts postdebridement complications reported with each method.


METHODS
I reviewed the pertinent neurosurgical papers from Vietnam, the Israeli war in Lebanon, and the Iran-Iraq war and compared the results of traditional debridement and water-tight dural closure to those following minimal debridement without close attention to dural closure.


RESULTS
Minimal brain debridements without tight dural closure were up to 20 to 30 times more likely to require additional debridement, had a 10-15 times higher incidence of life-threatening CSF leakage, a fivefold increase in postdebridement meningitis, and a 2.5 times greater risk of fatal meningitis.


CONCLUSIONS
Compared to thorough brain debridement and watertight dural closure, minimal debridements and nonwatertight dural closure give inferior results.
Carey
Michael E
ME
Louisiana State University, Health Sciences Center, New Orleans, Louisiana 70112, USA.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000209:etiology / Q000601:surgery*; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D002648:Child; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods; D013353:Subdural Effusion / Q000209:etiology; D016896:Treatment Outcome; D014857:Warfare