Prevention of infective complications of craniocerebral war wounds in Vietnam (1978-79).

Infective complications often occur after craniocerebral wounds caused by missiles. These dangerous sequelae are, in our experience, the chief cause of delayed death after injury. Initial contamination, the presence of retained bone and metal fragments acting as a nidus for microbial growth, and disturbances in cerebrospinal fluid (CSF) circulation, especially when the ventricular system is involved, are challenging problems in the management of missile wounds of the brain. We have analysed the significance of these factors in 295 cases of such wounds sustained in the war on the south-west border of Vietnam in 1978-79. In cases undergoing operation within 24 hours, the incidence of infection was 13.7%, rising to 31% when delay in excess of 72 hours after injury was unavoidable. We formed the opinion that the risk of infection was not significantly increased by failure to remove small inaccessible bone chips. The most formidable complication was CSF leakage which often resulted in infections of the central nervous system.