From the Research
The recommended management for scalp laceration trauma involves controlling bleeding, cleaning the wound, examining for underlying injuries, and closing the wound with sutures, staples, or the hair apposition technique, with a focus on minimizing morbidity, mortality, and improving quality of life. When managing scalp lacerations, it is essential to prioritize control of bleeding through direct pressure, as the scalp's rich vascularity can cause significant hemorrhage 1. The wound should be cleaned thoroughly with normal saline or mild antiseptic solution to remove debris and reduce infection risk, and examined carefully to assess depth and rule out underlying skull fractures or foreign bodies. For most scalp lacerations, closure with sutures is recommended, typically using 3-0 or 4-0 non-absorbable sutures like nylon or polypropylene, with local anesthesia administered before suturing 2. However, the hair apposition technique (HAT) has been shown to be a viable alternative, with advantages including fewer complications, shorter procedure time, less pain, and high patient acceptance 3. In fact, a study found that HAT was equally acceptable and perhaps superior to standard suturing for closing suitable scalp lacerations, with a trend toward better wound healing and fewer complications 3. Another study demonstrated the effectiveness of a modified hair apposition technique (modHAT) in repairing scalp lacerations, with high patient satisfaction and no reported complications 4. Key considerations in the management of scalp lacerations include:
- Controlling bleeding through direct pressure
- Cleaning the wound thoroughly
- Examining for underlying injuries
- Closing the wound with sutures, staples, or the hair apposition technique
- Administering tetanus prophylaxis if necessary
- Considering prophylactic antibiotics for contaminated wounds
- Monitoring for signs of infection and providing follow-up care. Overall, the goal of management is to minimize morbidity, mortality, and improve quality of life for patients with scalp lacerations, and the choice of closure technique should be based on the individual patient's needs and circumstances, with consideration of the latest evidence and guidelines 5, 1, 3, 4.