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Hair Apposition: Use of Tissue Glue vs. Standard Sutures

Am Fam Physician. 2002 Oct 1;66(7):1322-1323.

Ideal scalp laceration repair requires speed, minimal pain, cosmetic acceptability, and easy follow-up. The usual repair procedure is cleaning and suturing. This procedure is slow and requires shaving the hair around the repair site. A return visit is required for removal of sutures. Alternative techniques have included stapling, tissue adhesives, and hair knotting. Combinations of adhesives and knotting have also been attempted to minimize knot slippage and improve results. Ong Eng Hock and associates used a randomized, multicenter trial to evaluate a technique of managing scalp lacerations using hair apposition with tissue adhesive that avoids actual knotting. They compared this hair apposition technique (HAT) with standard suturing, using end points of wound healing, complication rates, procedure duration, pain perception, and patient satisfaction.

Patients of all ages with linear scalp lacerations of less than 10 cm in length, at least 3 cm of scalp hair, and no severe contamination or profuse bleeding were asked to participate. One hundred eighty-eight patients available for follow-up were assigned to wound closure with HAT or a standard suturing technique using injected local anesthetic and shaving or trimming of the surrounding hair. Those who had standard sutures were required to return in one week to have them removed.

In patients randomized to the HAT group, hairs on both sides of the wound were brought together with a single twist and secured with tissue glue. Patients were told they could wash their hair after two days and that the glue would gradually fall off. They were instructed to return for wound inspection after one week.

Wound healing was more satisfactory in the HAT group than in the standard suturing group; all four cases of wound breakdown occurred among those who had undergone standard suturing. Scarring was more common in the standard suturing group. There was no difference in infection or postprocedural bleeding between the two groups. The HAT procedure required less time, caused less pain by patient report, and was found acceptable by more patients than the standard suturing procedure. In addition, shaving and suture removal were not required.

The authors conclude that in patients who have enough hair of adequate length and whose scalp lacerations are not profusely bleeding or grossly contaminated, HAT may be a better scalp laceration repair technique.

Ong Eng Hock M, et al. A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study). Ann Emerg Med. July 2002;40:19–26.


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