[Facial-cerebral gunshot wounds]

The current frequency increase of gunshot wounds to the head is directly proportional to the access to firearms and to amount of firearm-related crimes. This risk is increasing especially in population groups that have not been threatened before. Hence the aim of this study was to analyse and resume our experiences in the management of faciocerebral gunshots. We retrospectively reviewed a series of 9 consecutive patients who were treated in the Department of Neurosurgery, Military Clinical Hospital in Bydgoszcz with the diagnosis of gunshot wound to the head from 1994 to 1999. All the cases were young males (mean, 26 yr). There were six suicidal attempts and three accidents at firearm service. KbkAK, that is a standard machine gun in the Polish Army, was most frequently related to gunshots in the analysed series. All the patients were assessed according to Glasgow Coma Scale (GCS) at arrival to hospital. Average of admission GCS Score was 6.1. The patients were also assessed after treatment using Glasgow Outcome Scale (GOS). One patient was dead (GOS Score 1), and 7 (78%) improved to good, independent functional status (GOS Score 4 or 5). The authors emphasize the necessity of multispecialistic initial operative management of faciocerebral gunshots wounds and aggressive pre- and postoperative care (tracheostomy, gastrostomy, treatment of encephalitis), which makes it possible to obtain good and very good outcomes. Furthermore, we stress the role of minimal primary debridement for the sake of frequent secondary reconstructive operations.