Scalp lacerations are tears of the scalp skin produced by blunt or sharp trauma. Because the scalp is richly vascularized, even small wounds can bleed profusely. Typical features include:
- Immediate heavy bleeding
Bright-red blood often streams down the face and neck; arterial spurting is possible if the deep temporal or occipital vessels are injured. - Visible gap or flap
The wound edges gape open, revealing sub-cutaneous fat, galea, or occasionally bone; hair may hide smaller defects. - Pain and localised tenderness
Sharp pain at the site, worsened by jaw movement or palpation; surrounding bruising and swelling develop quickly. - Swelling and hematoma
Rapidly forming soft or boggy mass under the scalp; a sub-galeal collection can extend across the entire forehead or occiput. - Matted hair and clot
Blood clots dry and glue hair together, forming a hard crust that can mask the true wound size. - Signs of deeper injury
Persistent clear fluid leakage (CSF), palpable skull depression, or visible bone fragments suggest associated skull fracture and warrant imaging. - Systemic effects
In infants, elderly, or anticoagulated patients, continuous oozing may lead to haemorrhagic shock: pallor, tachycardia, hypotension, and altered mental state.
Any scalp wound that continues to bleed after 10 minutes of direct pressure, exposes bone, or is accompanied by neurological symptoms requires urgent evaluation and layered closure.
| Symptom | Typical Findings | When to Suspect Complication |
|---|---|---|
| Bleeding | Heavy, rapid, arterial | Shock in vulnerable groups |
| Wound edges | Gaping, visible fat/bone | CSF leak → basal skull fracture |
| Swelling | Local hematoma | Extensive boggy mass |
| Pain | Sharp, localised | Persistent → deeper injury |
| Neurology | Usually intact | Confusion, CSF → CT head |
| Vital signs | Normal if small | Tachycardia, hypotension → resuscitate |