Incisions are made along lines that can be utilized to rotate the scalp, should it become necessary to perform plastic repair of the scalp. As much scalp as possible is preserved. A Contaminated pericranium is removed. Burr holes are made in intact bone adjacent to the area of damage. A margin of normal dura is exposed.
Bone is removed with rongeurs toward the area of contamination.
Figure 29 B Figure 29 C Contaminated dura is removed, preserving as much as possible for closure. Figure 29 D Damaged brain, blood clots, and foreign bodies are removed with gentle saline irrigation and suction. Removal of all bone fragments is of greater importance than removal of all metal fragments. The use of intraoperative ultrasound facilitates localization of fragments. The debrided track should remain open after debridement.