Assessment and management of scalp lacerations
- Judd E Hollander, MD
Judd E Hollander, MD
- Professor and Vice Chair Department of Emergency Medicine
- Thomas Jefferson University
- Martin Camacho, MSN, CRNP, ACNP-BC, ENP-BC
Martin Camacho, MSN, CRNP, ACNP-BC, ENP-BC
- Manager Department of Emergency Medicine
- The Reading Hospital and Medical Center
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Scalp lacerations are a common injury. Clinical evaluation should identify associated serious head injury, laceration of the galea, or bony defect of the skull. After hemostasis is achieved and the wound is irrigated, 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.
The assessment and management of scalp lacerations will be reviewed here. Minor wound management, methods of suture placement, and closure of skin wounds with staples are discussed in detail separately:
- Lee RH, Gamble WB, Robertson B, Manson PN. The MCFONTZL classification system for soft-tissue injuries to the face. Plast Reconstr Surg 1999; 103:1150.
- Hollander JE, Singer AJ. Laceration management. Ann Emerg Med 1999; 34:356.
- Saigal K, Winokur RS, Finden S, et al. Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Facial Plast Surg 2005; 21:214.
- Lammers RL. Methods of wound closure. In: Clinical Procedures in Emergency Medicine, 5th edition, Roberts JR, Hedges JR (Eds), Saunders Elsevier, Philadelphia 2010. p.592.
- Wu G, Calamel PM, Shedd DP. THe hazards of injecting local anesthetic solutions with epinephrine into flaps: experimental study. Plast Reconstr Surg 1978; 62:396.
- Reinisch J, Myers B. The effect of local anesthesia with epinephrine on skin flap survival. Plast Reconstr Surg 1974; 54:324.
- Atabey A, Galdino G, El-Shahat A, Ramirez OM. The effects of tumescent solutions containing lidocaine and epinephrine on skin flap survival in rats. Ann Plast Surg 2004; 53:70.
- Howell JM, Morgan JA. Scalp laceration repair without prior hair removal. Am J Emerg Med 1988; 6:7.
- Bennett RG. Selection of wound closure materials. J Am Acad Dermatol 1988; 18:619.
- Edlich RF, Becker DG, Thacker JG, Rodeheaver GT. Scientific basis for selecting staple and tape skin closures. Clin Plast Surg 1990; 17:571.
- Ritchie AJ, Rocke LG. Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial. Injury 1989; 20:217.
- Kanegaye JT, Vance CW, Chan L, Schonfeld N. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. J Pediatr 1997; 130:808.
- Brickman KR, Lambert RW. Evaluation of skin stapling for wound closure in the emergency department. Ann Emerg Med 1989; 18:1122.
- Orlinsky M, Goldberg RM, Chan L, et al. Cost analysis of stapling versus suturing for skin closure. Am J Emerg Med 1995; 13:77.
- MacGregor FB, McCombe AW, King PM, Macleod DA. Skin stapling of wounds in the accident department. Injury 1989; 20:347.
- Khan AN, Dayan PS, Miller S, et al. Cosmetic outcome of scalp wound closure with staples in the pediatric emergency department: a prospective, randomized trial. Pediatr Emerg Care 2002; 18:171.
- Stillman RM, Marino CA, Seligman SJ. Skin staples in potentially contaminated wounds. Arch Surg 1984; 119:821.
- Johnson A, Rodeheaver GT, Durand LS, et al. Automatic disposable stapling devices for wound closure. Ann Emerg Med 1981; 10:631.
- Edlich RF, Gubler K, Stevens HS, et al. Scientific basis for the selection of surgical staples and tissue adhesives for closure of skin wounds. J Environ Pathol Toxicol Oncol 2010; 29:327.
- Hock MO, Ooi SB, Saw SM, Lim SH. A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study). Ann Emerg Med 2002; 40:19.
- Ong ME, Chan YH, Teo J, et al. Hair apposition technique for scalp laceration repair: a randomized controlled trial comparing physicians and nurses (HAT 2 study). Am J Emerg Med 2008; 26:433.
- Karaduman S, Yürüktümen A, Güryay SM, et al. Modified hair apposition technique as the primary closure method for scalp lacerations. Am J Emerg Med 2009; 27:1050.
- Aderriotis D, Sàndor GK. Outcomes of irradiated polyglactin 910 Vicryl Rapide fast-absorbing suture in oral and scalp wounds. J Can Dent Assoc 1999; 65:345.
- Physical examination
- Diagnostic imaging
- INDICATIONS FOR SUBSPECIALTY CONSULTATION OR REFERRAL
- WOUND REPAIR
- Indications for primary closure
- Contraindications and precautions
- Surgical staples
- Modified hair apposition
- Simple interrupted sutures
- OTHER CONSIDERATIONS
- Tetanus prophylaxis
- Prophylactic antibiotics
- Bite wounds
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS