Scalp Laceration

1. See Also
   1. Laceration Repair
2. Precautions
   1. Exclude significant Closed Head Injury
   2. Hemostasis is critical
3. Management
   1. Hemostasis is primary initial concern
      1. Scalp Wounds bleed heavily
      2. Apply direct pressure
      3. Consider Raney Clips or Running O-Suture to temporize closure
      4. Consider figure of eight subcutaneous stitch to stop focal heavy bleeding
   2. Galeal Laceration >0.5 cm should be repaired (2-0 or 3-0 Absorbable Suture)
   3. Skin closure with staples (often preferred), or Nylon Suture (3-0 or 4-0)
      1. Staples should have a 1 mm space above skin to allow for easier removal
4. Technique: Hair Apposition
   1. Indications
      1. Linear Scalp Laceration <10 cm
      2. Minimum of 3 cm scalp hair
      3. Clean wound
   2. Technique
      1. Hold several strands of hair from each side of a Scalp Laceration
      2. Cross the two strands, twist for one full rotation and then pull each to either wound edge
      3. Apply several drops of Tissue Adhesive where the hairs cross
      4. Repeat once or twice along the course of the Laceration
   3. Follow-up
      1. Hair may be washed after 48 hours of procedure
   4. Advantages
      1. Less scarring than with standard suturing
      2. No shaving or suturing needed
      3. No increased risk of infection or bleeding
   5. Resources
      1. Hair Apposition Technique
         1. https://lacerationrepair.com/alternative-wound-closure/hair-apposition-technique/
      2. YouTube
         1. https://www.youtube.com/watch?v=sV8zbMoDkbc
   6. References
      1. Ong (2002) Ann Emerg Med 40:19-26 [PubMed]
      2. Hock (2002) Ann Emerg Med 40(1): 19-26 [PubMed]
5. References
   1. Forsch (2017) Am Fam Physician 95(10): 628-36 [PubMed]