Treatment for Scalp Laceration
The recommended treatment for scalp laceration includes thorough wound cleaning with irrigation, appropriate anesthesia, and closure with sutures, staples, tissue adhesives, or hair apposition technique depending on wound characteristics. 1
Initial Assessment and Preparation
- Evaluate the wound for size, depth, contamination, and location to determine the appropriate closure method 1
- Clean the wound thoroughly with irrigation using tap water or saline solution (100-1000 mL) to reduce infection risk 1
- Apply adequate anesthesia before wound manipulation:
- For adults: Topical anesthetics (LET: lidocaine, epinephrine, tetracaine) can be applied to open wounds for 10-20 minutes until wound edges appear blanched 1
- For children: LET solution at appropriate dosing (3 mL for children >17 kg; 0.175 mL/kg in children <17 kg) 1
- For deeper wounds: Infiltrative lidocaine can be used, ideally buffered with bicarbonate and injected slowly with a small-gauge needle to minimize pain 1
Closure Methods
Suturing
- Recommended for larger lacerations (>5 cm), heavily contaminated wounds, or those with irregular edges 2, 3
- Simple interrupted or running sutures can be used depending on wound characteristics 3
- Benefits: Provides secure closure and precise wound edge approximation 3
- Disadvantages: More time-consuming, requires anesthesia, and necessitates suture removal 3
Stapling
- Particularly effective for linear scalp lacerations with minimal tension 4
- Benefits: Significantly faster application than sutures (p=0.001) with comparable cosmetic outcomes 4
- Particularly useful in emergency settings or for uncooperative patients 4
Hair Apposition Technique (HAT)
- Suitable for lacerations in areas with hair ≥1 cm long 2
- Technique: Bundle 10-15 hairs across the wound, twist them together, and secure with cyanoacrylate tissue adhesive 2
- Benefits: Quick, inexpensive, no need for anesthesia or suture removal 2, 3
- Caution: Apply glue only to twisted hair, avoiding contact with scalp or wound 2
Tissue Adhesives
- Appropriate for small, clean lacerations under low tension 3
- Benefits: No need for anesthesia, quick application, no suture removal required 3
- Limitations: Not suitable for areas with high tension or heavily contaminated wounds 3
Special Considerations
- Scalp wounds tend to bleed profusely due to rich vascularity; apply direct pressure before definitive treatment 5, 6
- For children, consider topical anesthetics as first-line for pain control before any procedure 1
- In polytrauma patients, ensure thorough examination of the scalp after adequate cleaning, as lacerations can be obscured by blood and hair 6
- For superficial abrasions accompanying lacerations, cover with clean occlusive dressing after cleaning 1
Post-Closure Care
- Apply white petrolatum ointment to the wound (as effective as antibiotic ointment) 3
- Wounds can be wet as early as 12 hours after repair without increasing infection risk 3
- For pain management: acetaminophen, ibuprofen, and ice packs are recommended 1
- Monitor for signs of infection (increased pain, redness, swelling, purulent discharge) 1
- Suture removal timing: 7-10 days for scalp wounds 3
Common Pitfalls to Avoid
- Missing deep lacerations hidden by hair – thorough cleaning and examination are essential 6
- Inadequate hemostasis before closure can lead to hematoma formation 5
- Excessive tension on closure can cause tissue necrosis and poor cosmetic outcome 1
- Failing to recognize potential underlying skull fractures or deeper injuries 6
By following these guidelines, most scalp lacerations can be effectively managed with excellent cosmetic and functional outcomes.