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Scalp Suturing : Overview, General Principle

  • Posted on- Apr 16, 2018
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A laceration is a cut through the skin. A scalp laceration can require stitches (sutures) or staples. There are a lot of blood vessels in the scalp. Because of this, significant bleeding is common with scalp cuts.

Scalp lacerations are a common injury. Clinical evaluation should identify the associated serious head injury, laceration of the galea, or bony defect of the skull.

As hemostasis is accomplished and the wound is soaked, scalp lacerations are typically closed with surgical staples under local anesthesia.

Sutures may be preferred over staples for large, gaping wounds and to provide hemostasis for wounds with brisk bleeding.

Most scalp lacerations are caused if hit by a blunt object. The scalp "showers" when it is pinched between the skull and another object. If the incision is gaping, it usually does better with stitches. A small scalp cut can be managed at home.

Small scalp lacerations can often be closed with a method called the "hair apposition technique". HAT (hair apposition technique) can be an appealing option for children because it tends to minimize discomfort to the patient.

Contraindications to use of HAT (hair apposition technique) include hair length less than 3 cm, wound length greater than 10 cm, gross wound contamination, active bleeding, and wound tension.

After an actual wound cleansing and hemostasis, gather hair on both sides of the wound into 2 bundles, then twist these 180 degrees around each other.

Apply tissue adhesive to the hair to hold it in place. An assistant is usually required for this technique and the process is not necessarily easy.

Immediate care:

Hold pressure on the cut till bleeding stops. Scalp lacerations can bleed profusely. Direct pressure can be put on the laceration (ideally with sterile dressing material). If the continued pressure is needed, tie the cloth into place with a sling (triangular bandage).

Home care

The following guidelines will help the patient care for his laceration at home:

  • During the first 2 days, the patient may carefully rinse his hair in the shower to remove blood and glass or dirt particles. After 2 days the patient may shower and shampoo his hair normally.
  • Have someone help the patient and clean his wound every day:
  1. In the shower, wash the area with soap and water. Use a wet cotton swab to loosen and remove any blood or crust that forms.
  2. After cleaning, keep the wound clean and dry. Talk to the doctor about applying antibiotic ointment to the wound. Apply a fresh bandage.
  • The patient should not put his head below the water until the stitches or staples have been removed. This means no swimming.
  • The doctor may prescribe an antibiotic cream or ointment to prevent infection. Do not stop taking this medication until the patient has finished the prescribed course or the doctor tells the patient to stop.
  • The doctor may prescribe medications for pain. If no pain medicines were prescribed, the patient can use over-the-counter pain medicines. Follow instructions for taking these medications. Talk with the doctor before using these medicines, if the patient has chronic liver or kidney disease. Also, talk to the doctor if the patient has ever had a stomach ulcer or GI bleeding.


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