The use of vancomycin powder in the compound depressed skull fractures

• Published in: Clinical neurology and neurosurgery Vol. 225; p. 107570
• Main Authors: Uysal, Ece, Çal, Mehmet Alpay, Cine, Hidayet Safak
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2023; Elsevier Limited
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Cerebrospinal fluid; Craniotomy; Emergency medical care; Epidural; Fractures; Gram-positive bacteria; Head trauma; Hematoma; Humans; Infection presentation; Localization; Medical imaging; Mortality; Neurosurgery; Neurosurgical Procedures; Patients; Pneumocephalus - surgery; Postoperative Complications - surgery; Postoperative infection; Powder; Powders; Retrospective Studies; Skull; Skull fracture; Skull Fracture, Depressed - drug therapy; Skull Fracture, Depressed - surgery; Skull Fractures - surgery; Statistical analysis; Surgical outcomes; Surgical site infections; Surgical Wound Infection - drug therapy; Surgical Wound Infection - surgery; Tomography; Trauma; Vancomycin; Vancomycin - therapeutic use; Craniotomy; Skull fracture; Vancomycin; Head trauma; Infection presentation
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2022.107570

Compound or open depressed fractures (CDF) is one of the urgent operations of neurosurgery, as it can result in complications of infection. This study is reported to investigate the effect of topical vancomycin powder to the infection rates in the compound depressed skull fractures which have been operated on. This present study was conducted on 46 cases with compound depressed skull fractures which have been operated on. Cases were divided into two groups according to the use of subgaleal topical vancomycin powder during the operation. The preoperative and postoperative CRP levels, localization of the fracture, hospitalization time, operation length, dural injury, pneumocephalus, and mortality rates have been examined. In cases with dural injury and pneumocephalus, a statistically significant relationship was found between the use of topical vancomycin powder and the frequency of post-op infection (p < 0.001). It was observed that the incidence of postoperative infection was significantly higher in 12 (85.7%) cases with pneumocephalus and dural injury when vancomycin powder was not used. Also, it was observed that the post-operative infection level was significantly higher in fractures in the frontal and parietal regions without vancomycin powder(p < 0.05). The use of subgaleal topical vancomycin powder is an option to reduce the infection rates and mortality, especially in the cases of compound depressed fractures, which is considered as a dirty wound and prone to infection. It is especially recommended in the presence of dural injury and pneumocephalus. •Preventing of the infection rates is essential entity to reduce the mortality, morbidity and hospitalization.•Since CDFs are considered dirty wounds, they carry a risk of infection and preoperative antibiotic therapy is required.•Topical vancomycin is recommended for CDFs to avoid the side effects of antibiotics andearly surgical site infection.