What is the proper wound care for a scalp biopsy wound?

Scalp Biopsy Wound Care

For scalp biopsy wounds, keep the site clean and dry, apply antibiotic ointment (such as bacitracin) after cleansing, and cover with a clean, dry bandage—avoiding hair shaving which can cause long-term follicular damage.

Initial Wound Management

Cleansing Protocol

• Irrigate the wound thoroughly with warm or room-temperature clean water to remove any debris or blood clots 1
• Cleansing should be performed before applying any topical agents to reduce bacterial contamination 2
• Avoid hydrogen peroxide or povidone-iodine solutions, as these are more tissue-toxic than their common usage suggests 3

Topical Antimicrobial Application

• Apply bacitracin or mupirocin 2% ointment to the clean wound to reduce infection risk 2
• Cover the wound with a clean, dry bandage after antibiotic application 2
• For patients with known bacitracin sensitivity, mupirocin is an appropriate alternative 2

Scalp-Specific Considerations

Hair Management

• Do not shave hair around the biopsy site, as this increases the risk of long-term follicular damage 1
• If the patient has increased movement or friction at the site, apply lubrication or a foam pad rather than removing hair 1

Dressing Selection

• Use a thin nonadherent contact layer directly on the wound for optimal contact on the scalp's contoured surface 1
• Secure with a thin foam secondary layer and avoid adhesive tape directly on skin 1
• If tape is necessary for securing dressings, use silicone medical adhesive removers (SMARs) for removal to prevent skin trauma 1

Ongoing Wound Care

Daily Maintenance

• Change dressings daily while inspecting for signs of infection: increasing pain, redness, swelling, warmth, or purulent discharge 4
• Maintain good hand hygiene before and after touching the wound or dressing 2
• Keep the wound covered with clean, dry bandages until healed 2

Monitoring for Complications

• Scalp wounds can progress to severe infections including subgaleal abscess or necrotizing fasciitis if not properly managed 5
• Stop topical antibiotic use and seek medical evaluation if the wound does not improve within 1 week or if symptoms worsen 2
• Watch for signs of spreading infection that would require systemic antibiotics and possible surgical debridement 4

Common Pitfalls to Avoid

• Failure to adequately cleanse before applying topical agents reduces their effectiveness 2
• Using cytotoxic cleansing solutions (hydrogen peroxide, Dakin's solution, povidone-iodine) can impair healing 3
• Shaving scalp hair around the biopsy site causes unnecessary follicular damage 1
• Applying adhesive tape directly to scalp skin without proper removal technique can cause additional trauma 1
• Leaving wounds uncovered increases infection risk and delays healing 1, 2

When to Escalate Care

• Any signs of spreading erythema, increasing pain, or systemic symptoms (fever, malaise) require urgent evaluation 4, 5
• Wounds showing no improvement after 4 weeks of appropriate care may require advanced wound therapy consultation 1