From the Research
Management of a scalp laceration with exposed periosteum requires prompt medical attention, and the most effective approach is to clean the wound thoroughly, administer prophylactic antibiotics, and close the wound with staples or sutures, with staples being a faster and less expensive option 1. The initial step in managing a scalp laceration with exposed periosteum is to control bleeding with direct pressure using sterile gauze.
- Clean the wound thoroughly with normal saline or sterile water to remove debris and reduce infection risk, as supported by a study that found no difference in infection rates between tap water and sterile normal saline for irrigation of lacerations 2.
- For anesthesia, use 1% lidocaine with epinephrine (1:100,000) injected around the wound margins, avoiding direct injection into the laceration.
- Carefully inspect the wound for foreign bodies, bone fragments, or skull fracture.
- The exposed periosteum should not be removed but kept moist with saline-soaked gauze until definitive repair.
- For closure, use 3-0 or 4-0 non-absorbable sutures like nylon or polypropylene for the galea layer, followed by skin closure with similar sutures or staples, with staples being a viable option as they are faster and less expensive than sutures, and have been shown to have similar cosmetic outcomes 3, 1.
- Prophylactic antibiotics (such as cefazolin 1g IV or amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days) are recommended when periosteum is exposed to prevent infection.
- Tetanus prophylaxis should be administered if the patient's immunization status is incomplete or unknown.
- Post-repair care includes keeping the wound clean and dry for 24-48 hours, then gentle cleansing and antibiotic ointment application.
- Sutures can typically be removed in 7-10 days.
- Patients should be advised to seek immediate medical attention if signs of infection (increasing pain, redness, swelling, drainage, or fever) develop, as infections involving the periosteum can potentially spread to the skull or intracranial structures. It is also important to note that irrigation before primary closure may not significantly alter the rate of infection or the cosmetic appearance in clean, noncontaminated facial and scalp lacerations, as found in a study that compared irrigation with saline versus no irrigation 4.