[Epidural "sulmycin implant" coverage for local prevention of infection in surgical management of open craniocerebral injuries].

In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17%. In this paper the operative experience with 22 cases of penetrating head injuries is discussed. In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier. 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely. There were no signs of suppurative complications in superficial wounds or in the brain. 4 patients died due to their severe brain damage with multiple contusional lesions. Postoperative complications were as follows: one patient suffered extradural and one patient subdural rebleeding. Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered. The revision was done successfully using the "Sulmycin Implant". Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant".