It is not necessary to shave the scalp prior to closure; shaving actually increases the likelihood of a wound infection and produces a less desirable cosmetic result in the short term. In most cases, the hair can be brushed aside. One can also apply an ointment such as bacitracin zinc or petrolatum to mat down the hair adjacent to the laceration. Hair braiding has been described as an alternate closure technique. 13 Large galeal defects should be repaired if possible to prevent a wide, depressed appearance of the final scar and to minimize the development of a subgaleal hematoma. Buried 4-0 nonabsorbable monofilament nylon [e.g., Surgilene (Sherwood Davis & Geck)], or polypropylene [e.g., Prolene (Ethicon, Inc.)] interrupted or horizontal mattress sutures may be used ( Tab.l.§... , 38-1). In large wounds, the muscle layer may be approximated with 4-0 absorbable monofilament [e.g., Monocryl (Ethicon, Inc.)] or multifilament [e.g., Dexon (Sherwood Davis & Geck) or Vicryl (Ethicon, Inc.)] in a simple interrupted fashion. This also serves to reduce the apparent width and depth of the final scar. Conversely, the skin and muscle layers can be closed with a single suture layer through both structures. The skin can be closed with surgical staples or by simple interrupted nylon or rapidly absorbable braided [e.g., Vicryl rapide (Ethicon, Inc.)] sutures.14 It is helpful to leave the tails long and use sutures of a color different than the hair to facilitate removal. Tissue adhesive is not recommended for the scalp. A pressure dressing should be considered for the first 24 h on a deep laceration to prevent the formation of a hematoma. Patients who have sustained a significant scalping injury should be sent to the operating room for definitive repair.
Was this article helpful?