SCALP & FOREHEAD LACERATIONS

Question 1

Scalp Layers

Answer 1

S - Skin
C - Cutaneous Fascia
A - Aponeurosis (Galea)
L - Subaponeurotic space
P - Pericranium

Question 2

Scalp Blood Supply

Answer 2

External Carotid:
-occipital branch
-post auricular branch

Internal Carotid:
-supraorbital branch
-supratrochlear branch

Question 3

Clinical Features

Answer 3

Rule out:
skull fracture
Intracranual hemorrhage

Question 4

ED Management: Scalp

Answer 4

Anesthesia: infiltration or lidocaine-epinephrine-tetracaine
Irrigation: 30 cc syringe + 18 g needle
+/- Clip Hair, DO NOT SHAVE
Suture Galea: 4-0 absorbable (monocryl, vicryl)

Skin Closure:
4-0 non absorbable monofilament (ethilon, prolene) simple interrupted
OR
Staples
OR
4-0 rapid absorbing (vicryl rapide) simple interrupted
OR
Hair braiding

Removal 14 d

Question 5

Forehead Laceration: Classification

Answer 5

Superficial: skin
Deep: Skin + Frontalis Muscle

Question 6

ED Management: Forehead

Answer 6

Anesthesia: Local or suproorbital block
Irrigation: 30 cc syringe + 18 g needle
Frontalis closure: 4-0 absorbable (monocryl, vicryl)
Skin Closure: 5-0 or 6-0 non absorbable (ethylon)
Use stitches along skin tension lines and the hairline
Removal 5 d

Question 7

ED Management: Eyebrow

Answer 7

Anesthesia: Local or suproorbital block
Irrigation: 30 cc syringe + 18 g needle
DO NOT SHAVE OR CLIP - needed for landmarks
Minimal debridement
Align margins
5-0 non absorbind monofilament (?) (ethylon)