Because of a rich blood supply, loose connective, tissue and relatively loose attachment to the pericranium, scalp lacerations can lead to massive blood loss. During the resuscitation phase of trauma care, scalp hemorrhages should be controlled as rapidly as possible. If direct pressure is not effective, lidocaine with epinephrine can be infiltrated locally, and vessels can be clamped or ligated if still necessary. Early closure with irrigation and debridement is the best method to control bleeding. Wounds should be carefully examined prior to closure. Blood clots and debris should be cleaned away to examine for underlying fractures and galeal lacerations. Large galeal disruptions should be repaired, but small one can be left alone.
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