II. Precautions
- Exclude significant Closed Head Injury
- Hemostasis is critical
III. Physiology: Scalp Layers
- Skin
- Connective Tissue (contains vessels, nerves)
- Aponeurosis (galea, thick)
- Loose areolar tissue
- Pericranium (thin)
IV. Management
- See Laceration Repair for general wound management and closure
- Hemostasis is primary initial concern
- Galea
- Thin layer (differentiate from the very thin, friable pericranium that does not require closure)
- Typically adherent to overlying connective tissue and skin
- Attaches to the occipitofrontalis muscle
- Galeal Laceration >0.5 cm should be repaired (2-0 or 3-0 Absorbable Suture)
- Closure protects from infection to skull
- Closure also maintains symmetry of the occipitofrontalis muscle (otherwise may cause forehead wrinkling)
- Skin closure with staples (often preferred), or Nylon Suture (3-0 or 4-0)
- Staples should have a 1 mm space above skin to allow for easier removal
- Avoid compressing the stapler to firmly into the scalp (light pressure is sufficient and preferred)
- Avoid trapping foreign bodies within the wound
- Avoid trapping hair within the wound (risk of inflammation, scarring)
- Clip the hairs with scissors
- Mat down the remaining hairs with surgi-lube to push out of the way
V. Technique: Hair Apposition
- Indications
- Linear Scalp Laceration <10 cm
- Minimum of 3 cm scalp hair
- Clean wound
- Technique
- Hold several strands of hair from each side of a Scalp Laceration
- Cross the two strands, twist for one full rotation and then pull each to either wound edge
- Apply several drops of Tissue Adhesive where the hairs cross
- Repeat once or twice along the course of the Laceration
- Follow-up
- Hair may be washed after 48 hours of procedure
- Advantages
- Less scarring than with standard suturing
- No shaving or suturing needed
- No increased risk of infection or bleeding
- Resources
- Hair Apposition Technique
- YouTube
- References
VI. References
Images: Related links to external sites (from Bing)
Related Studies (from Trip Database) Open in New Window
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 274166008 |
| English | scalp tissue injury laceration, laceration of scalp (physical finding), laceration of scalp, scalp laceration, lacerations scalp, laceration of scalp (diagnosis), Scalp laceration, Scalp laceration (disorder) |
| Spanish | Laceración del cuero cabelludo, laceración de cuero cabelludo (trastorno), laceración de cuero cabelludo |
| Portuguese | Laceração do couro cabeludo |
| Italian | Lacerazione dello scalpo |
| German | Lazeration der Kopfhaut |
| French | Lacération du cuir chevelu |
| Dutch | laceratie van hoofdhuid |
| Czech | Lacerace skalpu |
| Japanese | 頭皮裂傷, ﾄｳﾋﾚｯｼｮｳ |
| Hungarian | Hajas fejbőr laceratio |
