Overview: scalp is the head of the Department of Defense violence outside the surface barrier, with greater flexibility and toughness, stress and tension force has a strong resistance. violence can therefore pass through the scalp and skull, brain, causing brain damage, and the scalp is intact or slightly damaged. The structure of the scalp skin and other parts of the body are quite different, the surface hair thick, rich blood supply, subcutaneous tissue, dense structure, with short fibers across the surface, subcutaneous tissue layer and subgaleal layer together, Trinity easily separated , during which the particles are rich in fat, have a protective effect. Subgaleal skull periosteum with a loose connective tissue between the gap, which can slide to the scalp, so it is the role of violence outside the buffer.
scalp injury is the most common primary brain injury in a, its scope may be minor abrasions to the scalp avulsion, its significance lies in the scalp injury help on the location and severity of head injury judgments. scalp injuries are often associated with different degrees of skull and brain tissue damage, as the invasion of the portal and intracranial infections secondary cause of intracranial lesions, so the reconstruction of the scalp after injury has been more and more attention.[Cause]
scalp injury is caused by what the?
nearly vertical when the role of violence in the scalp, the skull of the liner because often cause scalp scalp contusion or hematoma, severe can cause contusion; nearly diagonal or tangential force, because the sliding often leads to the scalp scalp laceration, lacerations, but to some extent, but also the role of violence in the skull on the buffer strength.
(B) the pathogenesis
1 is a combat sport with collision against a foreign head injuries. material injury due to the speed and size of the difference, can cause different damage, such as a large volume of material injury is slow, often resulting in scalp contusion and hematoma volume high speed faster then the resulting scalp laceration; small size and speed are often caused by a small scalp laceration, often accompanied by penetrating head injury.
collision is a moving head impact in the material world, is common in car accidents, falls, fall injury. in the area where the collision broad and even the material world, if slow, often caused by scalp contusion and hematoma, such as the collision speed is often caused by scalp laceration and with adjacent scalp contusion and skull fracture, while the collision in the area outside the narrow shape of the sharp objects over time, could easily lead to scalp laceration.
2. cutting and cutting stamp is due to wear sharp objects caused by acting on the scalp, often caused by scalp laceration edges neat. wear a stamp is due to sharp foreign objects caused by acting on the head, often resulting in regular or irregular scalp laceration, and often accompanied by open brain injury .
3. friction and friction is due involves violence was due to the tangential direction acting on the head, often resulting in scalp abrasions and contusions, and might cause some scalp avulsion . involves the scalp are due to strong traction force caused mainly seen in women braids involved in turning the wheel, often as large or full scalp of severe scalp laceration.
4. relative to the direction of extrusion is also acting on the head caused by violence, common in floor extrusion and birth trauma. In addition to parts of the scalp caused accomplish their goals contusion and hematoma, but is often associated with skull fractures or brain trauma.[Sign]
What are the early symptoms of scalp injury?
1. scalp laceration (scalp laceration) is a specialized scalp skin contains a lot of hair follicles, sweat glands and sebaceous glands, easy to hide dirt, bacteria, susceptible to infection. However, the scalp blood circulation is very rich, although the occurrence of scalp laceration, as long as the timely implementation of thorough debridement, infection is rare. Layers of the scalp in the subgaleal fascia is a layer of tough, it is not only an important structure to maintain scalp tension, but also the prevention of invasive intracranial superficial infection barrier. When the scalp laceration shallow Galeal not hurt when the gap is not easy to open, stop the bleeding vessel stump is difficult to back down, but more bleeding. If Galeal fracture, the wound was split, with the damage of vascular stump wound back, self-curing, therefore less bleeding.
(1) simple scalp laceration: often the result of stabbing or sharp cuts, cracks than the straight, neat wound edge without defect, the depth of the wound with injury factors more different, except for a few sharp poke directly or through hacking into the brain, resulting in open brain injury, most simply limited to the scalp laceration, sometimes as deep as the periosteum, but the intact skull often not accompanied by brain damage.
(2) complex scalp laceration: often a result of blunt head injury or caused the collision on the outer material, cracks and more irregular, the highest edge of a bruise marks, the highest within the gap There is connected between the fiber, not completely broken off, that is no "organization fell off" phenomenon, in the forensic identification, scalp laceration wound if a "tissue fell off," often implies metal lines or edges of the weapon caused. Patterns often reflect the wound size and shape of physical injury. Such trauma is often associated with skull fractures or brain damage, severe depression can also cause fractures or comminuted fractures holes intracranial penetration, it is often hair, cloth, or sand and other debris embedded foreign body, prone to cause infection. Check wounds Shenwu remove embedded intracranial foreign body, so as not to cause sudden bleeding.
(3) scalp lacerations: mostly oblique or tangential direction of the effect of violence on the scalp caused by tearing of the scalp is often the tongue or flap-like, often with a pedicle attached to the head. scalp laceration is generally not associated with the skull and brain damage, but not always the case, there are occasional skull fracture or intracranial hemorrhage. These patients more blood loss, but less reach the degree of shock.
2. scalp laceration (scalp avulsion) scalp avulsion is a serious scalp injury, because almost all the women inadvertently left braids hair volume into the rotating wheel walls. Because the epidermis, subcutaneous tissue layer and subgaleal layer 3 is closely connected together, so involved in the strong, often the scalp from the subgaleal space full-thickness avulsion, sometimes along with part of the periosteum are torn off, the skull exposed. scalp avulsion are involved in the scope and area of the hair root, severe up to the subgaleal coverage area, the former supremacy of the eyelids and bridge of the nose, the latter to the hairline, on both sides involving the ear or cheek. Patients with massive blood loss can cause shock, but less combined skull fracture or brain injury.
3. scalp hematoma (scalp hematoma) scalp is rich in blood vessels, suffered blunt blow or collision, can rupture blood vessels within the organization, and the scalp is still intact. Often in the subcutaneous tissue of the scalp hemorrhage, subgaleal or subperiosteal hematoma formation, location and type of help in their analysis of injury mechanisms, and can make the skull and brain damage estimates.
(1) hematoma: the subcutaneous layer of the scalp scalp's blood vessels, nerves and lymphatic collection of parts, easy bleeding after injury, edema. As the hematoma is located between the surface and subgaleal by subcutaneous fibrous septa has a special performance limitations: small size, high tension; pain is very significant; palpation when the center is slightly soft, hard around the bulge, is often mistaken for depression fracture .
(2) subgaleal hematoma: a lower subgaleal loose cellular tissue layers, there have been connecting the scalp and skull diploic veins and intracranial venous sinus lead vessel. When the head being inclined violence, scalp dramatic slide, causing the guide layer tear blood vessels, bleeding more easily spread, often caused a huge hematoma. Therefore, its clinical features are: a wide range hematoma, severe hematoma and subgaleal boundary edge attached to the same, the former to the eyebrow, then to the external occipital protuberance and nuchal line both sides of the zygomatic arch, like a hat top of the patient's head. hematoma tension is low, significant fluctuations, less pain, anemia appearance. infant huge subgaleal hematoma, which can cause shock.
(3) subperiosteal hematoma: skull subperiosteal hematoma, in addition to the baby due to birth trauma or due to fetal head to attract midwives who, in general, are associated with linear skull fracture. The source of bleeding, mostly due to diploic bleeding or periosteal stripping walls accumulation of blood in between the periosteum and the skull surface, and its clinical features are: hematoma perimeter beyond the suture, it is because the skull in the development process, the embedded clip periosteum within the suture, it is little more than suture subperiosteal hematoma, unless when skull fracture line across the two, but the hematoma will stop at another piece of skull bone joints.
1. scalp laceration due to sharp injuries, blunt injury walls, such as cuts or chopped, high-speed tip projection device injuries, head impact injuries. head laceration pain, with varying degrees of hemorrhage, because scalp blood is rich in blood vessels rupture easily self-closing, even if the wound is not bleeding is greater. Neat sharp edges of the wound injury, blunt injury jagged wound, can be linear or irregular in shape.
(2) subgaleal hematoma: subgaleal hematoma and periosteum located between the diffuse bleeding in the subgaleal space, easy to limit the widespread , hematoma wide range of severe head fornix throughout the subgaleal hematoma attached to the boundary and the edge is consistent, significant fluctuations palpable sense of, in infants, bleeding for a long time can be complicated by shock.
3. scalp avulsion of the scalp more from subgaleal or subperiosteal avulsion. avulsion of the whole scalp and subgaleal attached to the boundary edge of the same, the former to the eyelids and bridge of the nose, after the first entry line and fortune, to bilateral temporal, due to wounds, bleeding, shock easily.[Aftertreat]
scalp injury ate?[Prevent]
how to prevent damage to the scalp?
currently no related information[Treat]
scalp injury precautions before treatment?
(1) simple scalp laceration: the principle of treatment is early Shi Xingqing record suture, even after injury time-out 24h, as long as there is no obvious signs of infection, can be thoroughly cleaned create a suture at the same time should be given antibiotics and TAT injection.
debridement methods: shaved at least 8cm gap within the surrounding scalp, under local anesthesia or general anesthesia, wash the wound with sterile water, then use a soft brush dipped in disinfectant soap Ministry of water and brushing around the scalp record, complete removal of visible hair, sand and other foreign matter, then at least 500ml normal saline over, rinse the soap bubble. And then drying the wound with sterile dry gauze to iodine, alcohol disinfection of the skin around the wound, the bleeding point can be used for active clamp method oppression or temporary control until the debridement and then eleven complete hemostasis. General shop towel from the outside and inside layer debridement, wound edge trim is not too much, to avoid increasing suture tension. Remnants of the foreign body and loss of vitality of the organization should be removed, surgery to suture the subgaleal and skin. If they have difficulties in the direct suture can be subgaleal loose layer around the line to separate Shixing Song solution sutures after surgery; if necessary, can also be S-shaped gap, or flap-shaped extension of the trigeminal-shaped incision, to facilitate suturing, general hold drainage of subcutaneous (Figure 1). Were significantly larger and contaminated wound, suture set should be low poke drainage of the mouth, and at 24h after the extraction. After injury, who have 2 to 3 days can be a part of debridement or suture plus drainage. Postoperative prophylactic antibiotic treatment and intramuscular injection of tetanus antitoxin (TAT) 1500U (after the skin test negative).
debridement methods: preoperative preparation and method of wound debridement and wash as described above. As the scalp laceration after debridement is often accompanied by varying degrees of scalp defects, small defects should be noted that the repair method of the scalp.
of complex scalp laceration debridement should be good preparation for blood transfusion. Mechanical cleaning should be washed after anesthesia, so as to avoid pain stimulation cardiovascular adverse reactions. debridement of the scalp laceration should require plans to be extended, or for additional incision, so that a wound by suture or suture repaired. Wound edge trim is not too much, but it has lost its blood supply must be the setback edge cracked skin removed, in order to ensure wound healing. Part of the incomplete, the method can be used flap, wound debridement and closure will be for the skin area to retain the periosteum to the skin thickness skin graft coverage of the fault (Figure 3).
(3) scalp lacerations: Because the flap does not completely tear avulsion, always able to maintain some of the blood supply, debridement Do not tear or connected to the pedicle cut. Sometimes it seems a very narrow residual pedicle, it is difficult to provide adequate blood supply, but the whole unexpected flap survival.
debridement methods: as mentioned above has, in principle, in addition to carefully protect the residual pedicle, it should minimize the suture tension can be Galeal lower separation release cracks around the scalp, and then be layered suture. If the tension is too large, you should first ensure that the flap at the base of the suture, and the front part of the further relaxation of the flap or flap incision to repair.
(1) hematoma: scalp hematoma in a few days after the self-absorption, no special treatment given early cold compress to reduce bleeding and pain, 24 ~ 48h later changed to heat in order to promote absorption of hematoma.
(2) subgaleal hematoma: a small hematoma can be used for the early cold, pressure bandage, 24 ~ 48h later changed to heat, wait until the self-absorption . If the hematoma great, they should be under strict skin preparation and sterilization, aspiration after graded compression bandage, especially for infants and young children of patients, the interval 1 puncture 1 to 2 days, and under the circumstances to give antibiotics. hematoma were not disappear or continue to increase, the exclusion of skull fracture and intracranial injury can be inserted through the trocar tube drainage for several days, can also be cut to remove the hematoma and bleeding, tight suture the wound, bandaged, and apply antibiotics to prevent infection. infection should be incision and drainage of hematoma. Infants subgaleal hematoma can lead to systemic lack of effective circulating blood volume, blood volume necessary to supplement the inadequacy of the fashion needs.
(3) subperiosteal hematoma: early cold is still appropriate, but avoid using strong pressure bandage to prevent the flow of blood through the intracranial joint fracture, causing epidural hematoma, the larger should be strict skin preparation and sterilization in the case of the implementation of the puncture, aspiration of blood in 1 or 2 times can be restored. If the blood should be promptly repeated CT scan or other examinations. For smaller subperiosteal hematoma, we can use the first cold, hot wait until after the self-absorption method; but subperiosteal hematoma in infants, is often too long that is more calm calcium to form bone cladding, difficult to disperse of this hematoma aspiration should be timely, in carefully bandaged under close observation.
3. avulsion of scalp laceration scalp treatment, should first take active bleeding, pain, anti-shock measures. dressing covering the wound with sterile pressure bandage to stop bleeding and keep the scalp avulsion spare, sent to fight in the conditions of the hospital within 12h debridement. Based on the patient treatment time early-late, the survival of avulsed scalp conditions, the skull is exposed and whether signs of infection while using a different approach.
(1) reset the first flap replantation: about avulsion of the scalp after debridement underwent vascular anastomosis, in situ replantation. After injury for only 2 ~ 3h, no longer than 6h, the first flap complete, no pollution and vascular stump neat cases. Line head group and avulsion of the scalp wound irrigation, debridement, and then the main vascular supply to the scalp, superficial temporal artery and occipital vein or artery and vein stripping out line of small vessel anastomosis, if the one pair of arterial and venous anastomosis success , the first flap that is able to survive. As the scalp vein meager, ends are not sharp, often difficult.
(2) after debridement with autologous skin grafting: the scalp avulsion for no more than 6 ~ 8h, there is no obvious wound infection, periosteal than complete cases. Rinse the head wound after debridement, the patient abdomen or legs cut faults in thick skin, the skin graft. Also there will be no serious setback crack and carefully wash contaminated avulsed flap, debridement, shaved hair, including hair follicles, including subcutaneous tissue removed, leaving the epidermis, as the skin back to the plant to the head wound, but also can often be survived.
(3) advanced wound skin grafting: the scalp avulsion too long, the scalp wound Yiyou infection exists, the only line of wound dressings clean and exchange, to be granulation tissue growth after the late stamp-like skin graft line. If the exposed skull area, many holes need to line the outer plate, spaced about 1cm or so, so that vessels exposed plate barrier to the growth of granulation, covering exposed the skull, the re-seed-type skin graft, the eradication of the wound.
In recent years, promote the use of skin expansion technique, the silicone skin expander system time buried in the adjacent normal scalp wound, in the capsule into the water a few days interval, the capsule gradually expanded, the expansion of the scalp along slowly. Generally by 1 to 2 months, the expansion of the skin covering the use of repair defect. Using this method of repairing large scalp defect with satisfactory result.
(b) the prognosis
scalp injury generally good prognosis, because the scalp avulsion wounds, bleeding and prone to shock. infant subgaleal hematoma severe head fornix throughout the border with subgaleal hematoma attached to the edge, bleeding for a long time can be complicated by shock.
scalp injury should be how?
no special performance.[Diff]
scalp injury and the diseases easily confused?
1. differential diagnosis of various types of scalp hematoma (Table 1).
2. scalp hematoma and depressed fractures of scalp hematoma to identify tissue swelling around the thickening of the center contact there is a sense of depression, may be misdiagnosed as depressed fractures, and sometimes require x-ray film except for depressed fractures. Clinically, the edges by pressing hard to make edema dissipated, useful in differential diagnosis.[Disease]
hypothermia may be caused by the diseases?
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