What are the guidelines for managing a scalp laceration, including how long to keep the area dry and when it's safe to shower and wash hair?

Management of Scalp Lacerations: Wound Care and Hygiene Guidelines

For clean, non-contaminated scalp lacerations, you can allow patients to shower and wash their hair gently with water starting 24-48 hours after repair, keeping the wound moist with occlusive or semiocclusive dressings to promote faster healing. 1

Immediate Post-Repair Care (First 24-48 Hours)

• Keep the wound clean and dry for the first 24-48 hours after closure to allow initial wound sealing 2
• Apply an occlusive or semiocclusive dressing immediately after repair, as wounds heal faster in a moist environment 1
• Monitor the site daily for signs of bleeding, pain, erythema, induration, leakage, or inflammation 3
• Avoid occlusive dressings that trap excessive moisture, as these can promote skin maceration and increase infection risk 2

Showering and Hair Washing Protocol

• Patients may shower and gently wash their hair starting 24-48 hours after repair using clean tap water 1, 4
• Use only water or mild soap for cleansing—potable tap water is as safe as sterile saline and does not increase infection risk 1
• Avoid vigorous scrubbing or direct high-pressure water streams on the laceration site 1
• Pat the area dry gently after washing; do not rub 2

Ongoing Wound Care After Initial 48 Hours

• Continue using semiocclusive dressings between washings to maintain a moist healing environment 1
• Cleanse the wound with soap and water of drinking quality once or twice daily after the first 48 hours 3
• After 5-7 days post-repair, when the wound is well-healed, dressings can be reduced to once or twice weekly or omitted entirely 3

Important Clinical Considerations

Irrigation at Time of Repair

• For clean, non-contaminated scalp lacerations presenting within 6 hours of injury, irrigation before closure does not significantly reduce infection rates (0.9% with irrigation vs 1.4% without, P=0.28) 4
• However, thorough examination requires copious irrigation to remove coagulated blood and debris that may obscure wound edges, particularly important in scalp lacerations where hair can hide the true extent of injury 5

Timing of Repair

• There is no absolute "golden period" for scalp laceration repair 1
• Depending on wound characteristics, it may be reasonable to close lacerations even 18 or more hours after injury 1

Common Pitfalls to Avoid

• Failing to thoroughly examine the scalp: Hair and coagulated blood can effectively hide wound edges and lead to missed lacerations with serious sequelae including acute anemia 5
• Using excessive occlusive dressings: These promote maceration and infection 2
• Delaying wound checks: Early identification of complications allows for simpler intervention 2

Follow-Up and Suture Removal

• Perform a wound check at 48 hours to assess for signs of infection or dehiscence 6
• Timing of suture or staple removal depends on location and healing progress, typically 7-10 days for scalp lacerations 1
• Contact patients at 30 days to assess for delayed complications 6