Infection prevalence and patterns in self-inflicted gunshot wounds to the face

Algorithmic Approach to Antibiotic Prophylaxis for Traumatic Craniomaxillofacial Injuries

“…67,68 A retrospective cohort of 17 patients with self inflicted GSW found that 35% of patients developed infected wounds despite 88% receiving prophylactic antibiotics. 58 This was similar to another retrospective study of 33 patients with high energy GSWs to the head and neck with infections in 38% and 30% for delayed and immediate reconstructive groups, respectively. 69 There are no prospective randomized controlled trials regarding antibiotic prophylaxis for high velocity GSWs.…”

“…Frequently, empiric coverage is recommended, but rarely are specific regimens, prevalence of infections, and microbial patterns discussed. [58][59][60] Thoresby and Darlow 61 showed that bullets do not become sterilized upon firing. They also documented how a negative pressure phenomenon created by projectiles traveling through tissue can draw fragments of clothing and bacteria from the environment into the wound.…”

“…Some authors state that low velocity GSWs of the face should be treated similar to high velocity wounds as significant tissue avulsioncanstill occur at close range, as well as communication with the oral cavity. 58 Furthermore, fractures caused by projectiles are considered open fractures and thus when surgical intervention is warranted, patients would receive antibiotic prophylaxis as outlined in Figure 2. 62,67 The difficulty with performing prospective studies in this area is that it would be substandard to withhold antibiotics given the operative nature of these wounds, extent of damage, and increased risk factors for wound infection.…”

Ballistic projectiles removal in head and neck region

“…In this sense, the trauma pattern of PAF wounds is extremely variable, and can be classified as: penetrating, in which the projectile remains lodged in the injured tissue, usually caused by low-velocity projectiles (less than 1000 feet/s); perforating, where there is an entry wound and an exit wound; or avulsive, which involves tissue loss, and the latter is usually caused by high-velocity projectiles (more than 2000 feet/s) [1,2,[6][7][8]12,13].…”

“…Another factor to be considered is the fact that injuries caused by firearms are characterized as dirty wounds, because of the possibility of infection, not only by the projectile itself, but also by other contaminants such as of lead and gunpowder remnants, tissue, cartridge and teeth fragments, skin bacteria, and bone spicules, among others. And therefore, they should receive antibiotic and anti-tetanus coverage [5,9,12].…”