From the Research
For a bald patient with a laceration, suturing is generally preferred over stapling due to better cosmetic outcomes and less visible scarring. This is particularly important in exposed areas like the scalp where hair cannot conceal the healed wound. When suturing a scalp laceration on a bald patient, monofilament sutures such as 3-0 or 4-0 nylon or polypropylene are typically used. The wound should first be thoroughly cleaned, irrigated with normal saline, and anesthetized using 1% lidocaine with epinephrine (unless contraindicated). Sutures should be placed approximately 3-5 mm apart and removed after 7-10 days.
While staples are faster to apply and may be considered for very long lacerations or in emergency situations with multiple trauma patients, they generally leave more noticeable track marks and cross-hatching scars, as noted in a study comparing staples and sutures for skin closure of surgical wounds 1. This cosmetic disadvantage is particularly problematic for bald patients who lack hair coverage to hide these marks. Additionally, suturing allows for more precise wound edge approximation and better control of tension across the wound, which can improve healing and minimize scarring in the visible scalp area.
It's also worth noting that the hair apposition technique (HAT) with tissue glue has been shown to be effective in repairing scalp lacerations, with advantages including fewer complications, shorter procedure times, and less pain, as demonstrated in a randomized controlled trial comparing HAT with standard suturing 2. However, for bald patients, suturing remains the preferred method due to its superior cosmetic outcomes. A study on the comparison of skin stapling devices and standard sutures for pediatric scalp lacerations found that stapling was faster and less expensive, but this may not be directly applicable to bald patients where cosmetic concerns are more prominent 3.
In terms of specific suture materials, a study comparing absorbable plain gut versus nonabsorbable nylon sutures for traumatic pediatric lacerations found that absorbable sutures provided slightly better cosmesis, but this may not be directly relevant to the scenario of a bald patient with a laceration 4. Another study on essentials of skin laceration repair highlighted the importance of considering various suturing techniques and materials, including tissue adhesives, but emphasized that suturing is generally the preferred method for laceration repair 5.
Overall, the choice of suturing for a bald patient with a laceration is supported by the most recent and highest quality evidence, which prioritizes cosmetic outcomes and minimization of scarring in visible areas like the scalp.