How to deal with Scalp Lacerations with this “HAT” trick!

How many of you have heard of the Hair Apposition Technique, or perhaps even used it on a patient? I figured it existed since 2002, but have only learned about it recently!

Hair Apposition Technique, or HAT trick, is a creative method of approximating the scalp lacing by using the patient’s own hair as sutures.

Let me explain the steps:

  1. Irrigate your wound as usual, inspect for foreign bodies
  2. Pull together 3-7 strands of hair on one side of the wound.
  3. Do the same on the other side of the wound.
  4. Twist these two hair bundles in 360-degree revolutions. Do not tie a knot
  5. Secure the intertwined hair bundles by applying a few drops of Dermabond.
  6. Repeat as needed to close the length of the laceration.

If your patients have short hair, don’t worry, you can still use the HAT trick; all you need is two pairs of clamps.

Traditional staples/sutures have 3 advantages over them : 1) Zero pain (especially useful in kids; just tell them you’re braiding their hair!) 2) No need to anesthetize the wound (forget waiting for your nurses to first apply LET, then waiting more for it to kick in) 3) No need to return to ED for removal! The hair will unravel on its own after a week.

A quick tip for preventing loose hairs from entering your field of repair! When you try to staple Goldberg’s latest scalp lac and his hair keeps falling in, try using petroleum-based ointment instead. Apply ultrasound jelly (or grease) around the area to smooth down the strands, and spread them out to the sides as follows:

Using this method, you will not only be able to visualize the lac more clearly, but you will also be able to avoid trapping hair within the lac, which could cause wound dehiscence, a foreign body reaction, or local cellulitis.

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