Evolution of craniotomy as a debridement technique for penetrating craniocerebral injuries.

A craniotomy debridement technique was recommended for penetrating craniocerebral injuries as early as 1940, in World War II. However, with due consideration for the bacterial contamination of penetrating injuries, the safety of this technique was questionable. The technique has been recommended in each succeeding war, but no data substantiating the safety or eventual sequelae have been available. Analysis of the data from the large Head Injury Registry of Vietnam casualties indicates that, in properly selected cases, debridement by craniotomy technique can be safe and efficacious.