When a head injury results in an open wound, the decision to seek professional medical closure, such as stitches or staples, is often complicated by the vascular nature of the scalp. The scalp contains numerous blood vessels, meaning even small cuts can bleed profusely. While this bleeding can be alarming, it does not automatically indicate a severe injury. However, due to the proximity to the brain, a precise and prompt assessment is required to determine if professional closure is appropriate or if the wound is part of a larger medical situation.
Immediate Assessment: When to Seek Emergency Care
A cut on the head may be the least concerning part of a larger trauma, making the immediate triage of neurological symptoms paramount. Emergency medical attention is necessary if the injury is accompanied by signs of underlying trauma, such as a concussion or traumatic brain injury (TBI). These signs include loss of consciousness, confusion, or an inability to recognize people or places following the incident.
Other symptoms signaling an emergency include persistent, severe headaches that worsen, repeated vomiting, or discharge of clear fluid or blood from the nose or ears. Immediate care is also needed if the person experiences seizures, slurred speech, weakness, decreased coordination, or unequal pupil size.
Emergency care is also warranted if the bleeding is severe and cannot be stopped with firm pressure after 10 minutes. Bleeding that is spurting or gushing rapidly may indicate a severed artery. If a foreign object remains embedded in the wound, it should not be removed, and the person must be transported immediately for professional treatment.
Specific Wound Characteristics That Require Closure
Once underlying trauma is ruled out, the physical characteristics of the laceration determine the need for closure. The primary indicator that a cut needs medical closure is the wound’s inability to naturally approximate, known as gapping. If the wound edges pull apart and cannot be easily held together, stitches, staples, or glue are necessary to ensure proper healing.
The depth of the injury is another determining factor, as cuts that penetrate deep enough to expose underlying structures require closure. If white fatty tissue, muscle, or bone is visible within the wound, professional closure is necessary to prevent infection and promote healing. Lacerations generally deeper or longer than 1/2 to 3/4 of an inch often require medical attention and closure.
The location of the wound also impacts the decision, particularly where cosmetic outcome is a significant concern. Wounds that cross the hairline, are near the eyes, or are on the lip may require sutures for a finer, more precise closure that minimizes scarring. Additionally, wounds caused by a crushing mechanism or those contaminated by debris should be professionally cleaned and closed to reduce the risk of infection.
Methods Used for Head Wound Closure
A medical professional will choose from several established methods to close a head wound, depending on its characteristics and location.
Sutures
Sutures, commonly known as stitches, are the traditional method involving a needle and thread-like material to sew the wound edges together. Sutures allow for precise tension control and are often preferred for injuries in cosmetically sensitive areas, as they can lead to a less noticeable scar.
Staples
Staples are a faster alternative to sutures, frequently used for lacerations on the thick skin of the scalp. Applied with a special device, staples provide a secure, strong closure and are advantageous in emergency situations where speed is necessary.
Tissue Adhesive (Surgical Glue)
Tissue adhesive, or surgical glue, is a non-invasive option used for superficial, low-tension wounds that are straight and clean. This method is particularly appealing for children because it avoids the need for a needle and results in less post-operative discomfort. The glue creates a waterproof barrier that holds the edges together and eventually sloughs off as the skin heals, requiring no removal appointment.
Wound Care and Signs of Complication
After a head wound is closed, proper care is necessary to avoid infection and ensure optimal healing. The wound should be kept completely dry for the first 24 to 48 hours, after which gentle showering may be permitted with instructions to pat the area dry. Soaking the wound in a bath, hot tub, or natural body of water should be avoided until the closure material is removed, as this can introduce bacteria.
Non-absorbable sutures or staples will require removal, typically within 7 to 10 days for the scalp, though this varies based on the wound’s depth and location. Adhering to the doctor’s instruction for removal is important, as leaving them in too long can increase the risk of scarring or cause the material to become buried.
It is important to monitor the wound closely for signs of infection, which require immediate medical attention. These signs include increased or worsening pain, swelling, or warmth around the wound site. The presence of red streaks spreading out from the wound, pus or cloudy drainage, or the development of a fever are all indicators of a complication that must be evaluated by a healthcare professional.