In case of dirty compound penetrating skull injury, surgical debridement and cleaning the dirt inside the brain is the best option as in this case.

This striking example of American Democracy, which can be forced inside our brains. When the humanity of the American strategy come to a logical situation to stop pseudodemocracy and stop the evil  arising from the Republicans  and their allies including the NRA, which is still using the second amendment, which is suitable for the 17th century, but not now. It is time to wake up and stop destroying the world and start to preserve our plant from possible catastrophe. At the present time, we have only one planet, so please keep it in good shape.

The patient came to the clinic 20-April-2003 complaining of headache and oozing pus from the left parietal region. The patient during the US bombardment of the Bagdad Air Port 12 days ago got penetrating head injury with shrapnel and bone fragments inside the left parietal region. He was unconscious for several days and was transferred to several facilities, the last one is the KHMC. Nothing was done for him, but as the patient says he pray to God that he is still alive. A trail for conservative treatment was tried without improvement. Skull X-ray and CT-scan were done showing the shrapnel and osteomyelitis of the bone with abscess in the left parietal region.

On examination: the patient is alert with GCS 15/15, talking, walking and do not have striking neurologic deficit.

Porjectional straight incision over the bullet injury site left parietal region, The pus came out in big amount from the bone defect. The bone defect was widened. All the dirty material including the shrapnel, the osteomylitic bone fragments and the capsule of the abscess were sucked out and removed. Inspection of the cavity showing a normal brain structures around. Strict hemostasis. No CSF leak. Routine closure of the wound

Smooth postoperative recovery. He was sent to the ward.

The patient came to the clinic 10-June-2003 with clean wound and neurologically free, but he was advised to keep in Tegretol 400 CR twice a day for at least 6 months to prevent possible epi-attacks.

The patient then came 27-April-2004 convulsion free and he stopped medication the last 4 months. Upon inspection, he was told that there is no need for cranioplasty.