What is the treatment for a scalp hematoma?

Treatment for Scalp Hematoma

Conservative management with compression bandaging is the primary treatment for most scalp hematomas, with surgical drainage reserved only for cases where conservative measures fail or severe complications develop. 1

Initial Assessment and Classification

Scalp hematomas occur when blood accumulates beneath the galeal aponeurosis due to tearing of emissary veins in the loose areolar tissue. 1 The key clinical features to assess include:

• Size and location of the hematoma 1, 2
• Rate of expansion - rapidly increasing head circumference suggests massive subgaleal hematoma requiring urgent intervention 2
• Signs of hemodynamic instability - anemia, shock, or signs of significant blood loss 2
• Presence of infection - fever, leukocytosis, or signs of abscess formation 3
• Associated skull fractures or intracranial injury - requires imaging if suspected 1

Primary Treatment Approach

Conservative Management (First-Line)

Non-elastic bandage compression is the recommended initial treatment for uncomplicated scalp hematomas. 1 This approach includes:

• Direct compression with bandaging to prevent further accumulation and promote resorption 1
• Close observation for progression or complications 1
• Pain management as needed 1
• Monitoring for signs of infection or expansion 2, 3

Most scalp hematomas are self-limited and resolve with conservative treatment alone. 1

Indications for Surgical Intervention

Surgery should be considered only when:

• Conservative management fails after appropriate trial 1
• Massive hematoma causing severe symptoms or hemodynamic compromise 2
• Infected hematoma requiring drainage 3
• Continued expansion despite compression 2
• Severe complications develop 1

Surgical Options When Required

When surgery is necessary, the approach depends on the specific presentation:

• Incision and drainage for large, symptomatic hematomas that fail conservative treatment 1
• Complete evacuation for massive subgaleal hematomas causing systemic effects 2
• Debridement if necrosis or infection is present 3

Special Considerations

Neonatal Scalp Hematomas

Birth-related scalp hematomas require particular attention:

• Subgaleal hematomas in neonates can be life-threatening due to the large potential space and risk of hemorrhagic shock 2, 3
• Secondary healing is often successful for pressure necrosis 3
• Split skin grafting may be required for extensive necrosis 3
• Secondary reconstruction with tissue expansion may be needed for scarring and alopecia 3

Scalping Injuries

For traumatic avulsion injuries:

• Replantation is the treatment of choice and should always be considered, even with badly damaged scalp 4
• Proper specimen care includes cooling, cleaning, and preservation 4
• Hemodynamic stabilization without damaging potential donor vessels 4
• Antibiotics and hemodilution optimize outcomes 4

Common Pitfalls to Avoid

• Premature surgical intervention - Most hematomas resolve with conservative treatment; avoid unnecessary surgery 1
• Inadequate compression - Ensure proper bandaging technique to prevent reaccumulation 1
• Missing massive subgaleal hematoma - Rapidly increasing head circumference requires urgent evaluation and intervention 2
• Delayed recognition of infection - Monitor closely for fever, leukocytosis, and signs of abscess 3
• Failure to assess for underlying skull fracture - Consider imaging when mechanism or examination suggests possible fracture 1

Monitoring and Follow-up

• Outpatient follow-up for uncomplicated cases to ensure resolution 1
• Hospital admission for massive hematomas requiring close observation 1
• Serial examinations to detect complications early 2
• Long-term follow-up for cases requiring surgical intervention to assess for scarring or alopecia 3