Derm

Scalp Laceration

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Scalp Laceration, Scalp Repair, Scalp Wound, Hair Apposition Technique

  • Precautions
  1. Exclude significant Closed Head Injury
  2. Hemostasis is critical
  • Physiology
  • Scalp Layers
  1. Skin
  2. Connective Tissue (contains vessels, nerves)
  3. Aponeurosis (galea, thick)
  4. Loose areolar tissue
  5. Pericranium (thin)
  • Management
  1. See Laceration Repair for general wound management and closure
  2. 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
  3. Galea
    1. Thin layer (differentiate from the very thin, friable pericranium that does not require closure)
    2. Typically adherent to overlying connective tissue and skin
    3. Attaches to the occipitofrontalis muscle
    4. Galeal Laceration >0.5 cm should be repaired (2-0 or 3-0 Absorbable Suture)
      1. Closure protects from infection to skull
      2. Closure also maintains symmetry of the occipitofrontalis muscle (otherwise may cause forehead wrinkling)
  4. 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
    2. Avoid compressing the stapler to firmly into the scalp (light pressure is sufficient and preferred)
  5. Avoid trapping foreign bodies within the wound
    1. Avoid trapping hair within the wound (risk of inflammation, scarring)
    2. Clip the hairs with scissors
    3. Mat down the remaining hairs with surgi-lube to push out of the way
  • 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]