Open skull fractures with brain fungation: Simple principles for good outcome ? Our experience

The incidence of head injuries is increasing worldwide. The associated skull fractures are also increasing with rise in vehicular traffic. In the present study, a total of 214 cases of head injuries which were admitted into a Rangaraya Medical College Hospital from the time period of 2 years, were taken for the study. Out of them 124 cases presented with skull fractures ranging from simple linear to stellate, depressed, comminuted, compound and compound comminuted depressed fractures. Some fractures were extending to the base of skull and some to the vault and some were associated with facio-maxillary injuries. 17 cases out of the 124 open skull fractures, presented with cerebro-spinal fluid leak and brain matter seen directly herniating through the wound. The wounds in all the cases were contaminated, with many cases harboring hair, sand particles etc. Majority of them were secondary to road traffic accidents, but assaults and some directly hitting injuries under the influence of alcohol were also included. As there was an evident CSF leak and brain matter already present in the wounds, all the cases were taken up for emergency surgery. In spite of the grossly contaminated wounds, thorough wound debridement and closure of defects and duraplasty wherever feasible, resulted in very good improvement in all the cases. No mortality or procedure related morbidity was observed in any of these cases.