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Hair Apposition Technique: How to Fix a Scalp Cut?

Cuts and lacerations of the face and scalp are common and urgent concerns for patients seeking care at Aviva Plastic Surgery, and our facial plastic surgeon, Dr. Inessa Fishman, frequently repairs cuts with stitches.  There is a treatment technique to repair scalp cuts without sutures, however, and Dr. Fishman says it’s important to know how to do this treatment–called the hair apposition technique–in case your child, family member, or friend ever gets a scalp laceration.

“As a surgeon, I love cutting and sewing and helping people feel and look better,” says Dr. Fishman, “and as a Mom, I know how common boo-boos and cuts can be.  If you’re a parent or have young kids in your life, it’s a good idea to have the hair apposition technique in your back pocket in case your child–or someone close to you–gets a deep scalp cut.”


What is the Hair Apposition Technique?

Hair Apposition Technique or HAT is an alternative to using sutures to repair scalp lacerations; it is a treatment which uses the scalp hair to close a scalp cut and help it heal. For big cuts on a head full of hair, most healthcare providers will choose to use sutures or staples to close the wound. In controlled settings like the Emergency Room or our Plastic Surgery clinic, sutures are quite successful in both closing a wound and leaving minimal scarring afterwards. However, for smaller cuts, or if you are in an environment where the ER is not readily available, or if you want to avoid the long wait and various contagious illnesses sometimes associated with the ER, the Hair Apposition Technique can help you repair a scalp cut without stitches.

The Hair Apposition Technique works by using the hair around a scalp laceration to bring together the skin edges of the cut; it is the use of the scalp hair to repair a scalp cut–while using the hair strands like stitches. To start HAT, you must apply a few minutes of pressure to stop as much bleeding as possible–and scalp wounds can bleed quite a bit! After controlling bleeding and cleaning the wound, twist 4-8 small strands of hair on opposite sides of the wound to form “shoelaces.” Next, twist two opposing strands of hair around each other–like a twist tie–until they begin pulling the skin close and taut over the wound. Secure the twisted together hair strands with hair elastic, or use liquid bandage to hold the strands together.  Repeat the twisting together of the opposing hair strands until the cut is closed and no longer gaping.  For a very small cut, one pair of opposing hair strands may be enough to close the laceration.

For step-by-step instruction, check out this instructional video created by Emergency Medicine Physician Dr. Brian Lin (note the video contains graphic footage of a scalp laceration).


Does the Hair Apposition Technique work well?

The Hair Apposition Technique has been studied for its use in emergencies outside the medical setting, as well as in the hospital. Studies show patients prefer the aesthetic results from HAT treatments as compared to sutures
(especially when suture repair requires shaving hair), and physicians have not noted a significant treatment outcome difference between using sutures and HAT in the medical setting.  “This is pretty impressive for a non-surgical treatment,” says Dr. Fishman, “and it can potentially save you a stressful trip to the local ER–with great results to boot!”


When should the Hair Apposition Technique not be used?

Cuts that are actively bleeding and cannot be controlled with pressure require medical attention and potentially stitches or some other treatment to control both bleeding and the laceration itself, says Dr. Fishman, noting that HAT should not be used in this setting.  HAT is also not the treatment of choice in a very dirty wound (like a cut with glass or rocks or dirt embedded in it) or loss of tissue.  It also cannot be effectively used on scalps which are bald or have very short hair.


“Learn the simple Hair Apposition Technique and keep it in mind if you’re faced with a scalp cut,” says Dr. Fishman.  “The scalp has a very rich blood supply, and because of this, it tends to be very forgiving and heal well,” she notes, and in instances of small to moderate scalp lacerations, the Hair Apposition Technique can help you provide the care necessary for good healing and potentially avoid a rushed trip to the ER or our office.

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