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PostPosted: Tue Jan 05, 2016 2:57 am 
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Hi - I had a situation come up in the field and my solution seemed like a bodge, so I thought I would ask. A girl (age 10) had a mild head injury (older sister from a different mother in a polygamous family threw a heavy rock at her head) and there was soft tissue damage and plenty of bleeding. I wanted to put some butterfly bandages on the injury to close the would and keep her from getting a big scar that would show easily (African girls wear their hair very short in these parts).

Anyway, after cleaning the would I couldn't get the strips to stick because I couldn't get the hair short enough with scissors. I used a ton of tape on a sterile gauze pad, but was very unsatisfied with the result. I should mention that this was in a place with NO other medical care, so there was no way to get stitches put in. She turned out OK (no infection), but there is a scar.

Do folks routinely carry razors? Is there another solution?


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PostPosted: Tue Jan 05, 2016 4:32 am 
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For a head wound like that there will probably be a scar regardless of what you do, even if you use stitches.

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PostPosted: Tue Jan 05, 2016 6:20 am 
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Try this next time. You could use the hairs as sutures, combined with some superglue:

http://lacerationrepair.com/alternative ... technique/

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PostPosted: Tue Jan 05, 2016 7:28 am 
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It really depends on the history of the incident, your assessment, the size of the wound, a lot of things. Honestly, it could have been stapled (if you had it and they were like 12 or 13). Tieing the hair along with staples is done. I use a battery powered clipper with the dogs, that is KEY to carry when you may treat them also. But then again, battery powered clippers can suck. JIM's right though, the docs here do tieing. You just gotta clean that wound out before you do anything I'd say.


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PostPosted: Tue Jan 05, 2016 10:45 am 
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Assuming the wound is clean enough to close (sounds like it was)* then skin glue and/or steri-strips + tincture of benzoin. Both of those will tolerate a little bit more stubble. I've had trouble getting common drugstore butterflys to stick reliably on regular skin, I'm spoiled by steri strips& benzoin usually.

Hair tying is great - IF her hair is long enough to tie! If the concern for scar is b/c she wears it short, might be too short to tie well.

There will probably be a scar in any case, but there's a difference between a little line of a scar and a quarter-sized or better bald patch scar on somebody who favors a real short haircut. I don't know how long ago this was - scars are at their worst (red/puffy) at about 6-8 weeks - by 6 months they've usually settled down most of the way. If this was recent - it may look better by summer.

*(obvious thing is obvious) if it's not clean enough to close, just do exactly what you did, in a place with no medical care the infection is a far far bigger problem than the scar...

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PostPosted: Wed Jan 06, 2016 4:43 pm 
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Thanks for the tip on the hair. I will have to practice that a bit, I can see.


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PostPosted: Sun Jan 10, 2016 12:00 pm 
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If you have the training and means (to say nothing of the licensure) to do so, staples. All day, everyday. I've found that every other means of wound closure pales in comparison.

Staples are quick, require relatively little skill, and in every instance that I can remember from personal experience, did not require any level of local anesthesia. Nor have I ever needed to trim or cut the surround hair to close these wounds. Simply part the hair along the laceration margins before stapling.

I gave hair ties one good college try. The closure was marginal at best, and the poor kid had the WORST experience when the knots were cut. The dried blood and scabby mess incorporated a good deal of surrounding hair such that when the knots were cut, a fair amount of hair pulling was necessary to remove everything. Same goes for applying anything tacky to the scalp. May not be, but good potential of the closure being poorly tolerated if dermabond, benzoin, etc is used.

If I were ever tasked with closing a scalp wound outside of work, I'd almost certainly just suck it up and go to the ED or Urgent Care and get the 'railroad tracks laid'

As far as scarring, usually there will be a visible scar once the lac has healed. Usually only noticable if the person keeps their hair closely cropped or if it's along a visible portion of the hairline (temples/brow). Really not much that can be done to mitigate this.

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PostPosted: Sun Jan 10, 2016 2:07 pm 
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I once was in a hurry and working with a new BLS crew in a new town. This is an area with one medic intercept unit. I had intercepted for a chest pain. I did some care in the house, followed the stretcher out to be loaded in, I literally ran and jumped in first. I just forgot to duck enough and knocked myself out on the back end of the ceiling bar. I woke up about twenty seconds later lying supine on the ground with the crew and patient looking down, all three asking if I was ok.....I remember I had a baseball hat on and it was knocked off. I now had a chest pain patient, a scared crew, and a two inch laceration on the top of my head just gushing blood like a fawcett. I also felt like I had a compression fracture in my neck. I got up and said, "yep, load him up", grabbed my hat and used it to catch the blood pouring off my head. Got on the jump seat and was like, "give me a minute, then go". The patients now bugging out, I'm scrambling for a trauma dressing in the back cabinets, I'm now holding one on my head directing the tech in back on what to do. I'm doing the patch into the hospital and at the end I tell them that im pretty sure I'm going to need some staples and I need to get them and get out of there. We wheel the patient in, do turn over, and I see the mayo stand on the other side of the bed has a visistat (stapler) on it. I move the patient over. Then I say something stupid like, "excuse me for a second" to the patient. I pull the curtain , and luckily, the doctor was pretty familiar with my adventures so he comes over and no shit, opens the stapler and bangs 13 staples in. I have always had a shaved head so hair was no issue, but, the whole time, never went out of service, never shut my radio off, worked the whole shift. I'm a firm believer in staplers......and I got a cool scar on top of my melon. :crazy:


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PostPosted: Sun Jan 10, 2016 2:35 pm 
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Inject lido if available, followed by judicious application of a disposable razor, irrigate with saline, then staple if needed, results of which can be seen here....
Image
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Apologies for the fuzzy focus, it was difficult to take a shot of this in the mirror.

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PostPosted: Sun Jan 10, 2016 3:00 pm 
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dam dude, remind me to teach you how to approximate the wound better. it looks like it was starting to heal, how long after initial wound did you staple?......yeow, that was a self-service job?


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PostPosted: Mon Jan 11, 2016 5:57 am 
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IANMCDEVITT wrote:
dam dude, remind me to teach you how to approximate the wound better. it looks like it was starting to heal, how long after initial wound did you staple?......yeow, that was a self-service job?

It was stapled maybe an hour after the initial wound, by our "medics", a couple of very nice EMTs, while sitting in an old wooden chair doing my part by trying my hardest to coagulate as quickly as possible. :lol: One of them was reading the instructions for the stapler to the other as they went. It was a learning experience for them. :awesome:

It healed horribly, looking like one of the ridges on Klingon's forehead. I think the rear portion of the wound, which was "loose" from my skull...I accidentally slipped my fingers in there when I reach up to feel how bad it was, simply lifted up with swelling and the staples acted like a hinge.
So, after about 2 weeks I plop back down in the same old wooden chair and let them have a go at "revising" the scar. One half they simply used a scalpel to shave the ridge down, kinda like using a draw knife, The other half they cut out a skinny full thickness wedge/sliver of skin.....nicking something in the process, which is when they got to practice using the cauterizer.
Did you know I smell like BBQ when I'm cooked? :clap: My comments to them (polite and dignified, of course) resulted in them threatening to scratch their initial on my skull before re-closing the wound.
Again, a learning experience for them.


Here it is now, after a decade......
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PostPosted: Sun Nov 12, 2017 8:29 am 
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Cutting or shaving hair is usually not indicated in back country medicine.

As a matter of fact, you can use that same hair to approximate the wound. Twist it in your fingers to make "cordage", approximate the wound and tie the hair to close.

roscoe wrote:
Hi - I had a situation come up in the field and my solution seemed like a bodge, so I thought I would ask. A girl (age 10) had a mild head injury (older sister from a different mother in a polygamous family threw a heavy rock at her head) and there was soft tissue damage and plenty of bleeding. I wanted to put some butterfly bandages on the injury to close the would and keep her from getting a big scar that would show easily (African girls wear their hair very short in these parts).

Anyway, after cleaning the would I couldn't get the strips to stick because I couldn't get the hair short enough with scissors. I used a ton of tape on a sterile gauze pad, but was very unsatisfied with the result. I should mention that this was in a place with NO other medical care, so there was no way to get stitches put in. She turned out OK (no infection), but there is a scar.

Do folks routinely carry razors? Is there another solution?

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