Hematoma of the scalp
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Hematoma of the Scalp: Insights and Management
Introduction to Scalp Hematoma
A hematoma of the scalp is a localized collection of blood outside the blood vessels, often caused by trauma or surgical procedures. It can present in various forms and may require different management strategies depending on the severity and underlying causes.
Drainage Techniques for Scalp Hematoma
Simple Drainage Method
A straightforward method to drain a scalp hematoma involves using a 14-gauge intravenous cannula. This technique allows for the collection to be drained by simple suction, followed by the application of a compressive dressing to promote external drainage. Antibiotic therapy is recommended until the drainage is complete. This method is considered simple, safe, rapid, and cost-effective for managing small hematomas.
Pediatric Considerations
Scalp Hematoma as a Predictor of Intracranial Injury
In pediatric patients, particularly those under 24 months, scalp hematomas can be indicative of intracranial injury (ICI). Characteristics such as the location (temporal/parietal and occipital regions) and size (large and boggy) of the hematoma are associated with higher odds of ICI. The presence of a linear skull fracture only partially explains this relationship, suggesting that even without a skull fracture, the risk of intracranial pathology remains significant .
Timing of Presentation
The timing of presentation in children with scalp hematomas is crucial. Children presenting more than 24 hours after a head injury generally have better outcomes and may not require immediate neuroimaging if they do not exhibit red flags such as neurological symptoms or severe injury mechanisms. A wait-and-see approach might be more appropriate for these patients.
Special Cases and Rare Causes
Subgaleal Hematoma
Subgaleal hematomas, which occur in the potential space between the galea aponeurotica and the periosteum, can result from minor trauma or even hair combing in children. These hematomas can extend significantly and may resolve without intervention, although careful monitoring is necessary to rule out underlying conditions such as bleeding disorders or abuse .
Hematoma from Medical Procedures
Hematomas can also occur as a side effect of medical procedures such as platelet-rich plasma (PRP) therapy and hair transplantation. In such cases, aspiration and compression bandages are effective in managing the hematoma.
Management Strategies
Observation and Conservative Treatment
In infants, most scalp hematomas resolve spontaneously within a month. If the hematoma persists, conservative treatments such as haemostats or needle aspiration may be necessary to prevent complications like calcification.
Neurosurgical Intervention
In rare cases, such as patients with extensive scalp burns, neurosurgical intervention may be required to evacuate chronic subdural hematomas. A multidisciplinary approach, including careful wound management, is essential to avoid complications.
Conclusion
Scalp hematomas, while often benign, can be indicative of more serious underlying conditions, especially in pediatric patients. Management strategies range from simple drainage techniques to conservative observation and, in rare cases, surgical intervention. Understanding the characteristics and appropriate treatment options for scalp hematomas is crucial for effective patient care.
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