What is the treatment for an infected scalp laceration?

Treatment of Infected Scalp Laceration

For infected scalp lacerations, treatment should include wound irrigation, debridement of necrotic tissue, and appropriate antibiotic therapy with cephalexin or anti-staphylococcal penicillins for moderate to severe infections. 1

Initial Assessment and Management

• Wound Examination: Thoroughly clean the wound with sterile normal saline to properly visualize the extent of infection 2

  • Remove superficial debris but avoid aggressive debridement that could enlarge the wound
  • Assess for signs of infection: redness, warmth, pain, purulence, or surrounding cellulitis

• Wound Culture: Obtain a wound culture before starting antibiotics if purulent drainage is present 1

  • This helps guide antibiotic therapy if initial treatment fails

Antibiotic Therapy

First-line Treatment:

• Oral antibiotics for moderate infections:
  • Cephalexin 500mg four times daily for 7-10 days 1
  • Anti-staphylococcal penicillins (e.g., dicloxacillin) if available 1

Alternative options:

• For penicillin allergy: Clindamycin 300-450mg four times daily 1
• If MRSA suspected: Consider trimethoprim-sulfamethoxazole or doxycycline 1
  • MRSA should be suspected if:
    • Local MRSA prevalence is high
    • Patient has risk factors for MRSA
    • No response to initial therapy

Topical Treatment:

• Apply mupirocin 2% ointment to the wound three times daily 1
• For more extensive infections, consider silver-containing dressings 1

Wound Care

• Irrigation: Clean the wound thoroughly with sterile normal saline 2
• Debridement: Remove any necrotic tissue to promote healing 1
• Dressing: Apply appropriate dressing based on wound characteristics
  • Keep the wound clean and dry
  • Change dressings daily or more frequently if heavily exudative

Follow-up and Monitoring

• Reassess the wound after 48-72 hours of treatment 1
• Monitor for signs of worsening infection:
  • Increasing redness, warmth, pain
  • Purulent drainage
  • Fever or systemic symptoms
• Escalate care if infection extends beyond the immediate wound area or if systemic symptoms develop 1

Special Considerations

• Environmental exposure: For lacerations exposed to fresh water, consider coverage for Aeromonas hydrophila, as many strains are not sensitive to common antibiotics used for wound infections 3

• Potential complications: Be vigilant for signs of more serious complications such as subgaleal abscess formation, which may require surgical intervention 4

Common Pitfalls to Avoid

• Inadequate cleaning: Failure to thoroughly clean and irrigate the wound can lead to persistent infection 2
• Missed diagnosis: Scalp lacerations can be easily overlooked, especially in patients with thick hair or multiple injuries 5
• Inadequate debridement: Failure to remove all necrotic tissue can lead to persistent infection 1
• Ignoring MRSA possibility: Treatment failure may occur if MRSA is not considered in areas with high prevalence 1

By following this approach, most infected scalp lacerations can be effectively managed with good outcomes and minimal complications.