Scalp hematomas and lacerations

Scalp hematomas and lacerations are common types of head injuries in children and infants. Although often minor, these injuries may sometimes be indicative of underlying skull fractures, intracranial hemorrhages, or non-accidental trauma (child abuse). In Bangladesh, children frequently sustain such injuries due to falls, road traffic accidents, playground trauma, or domestic mishaps. Accurate diagnosis and early intervention can prevent complications and long-term neurological damage. Dr. Md. Nafaur Rahman, one of the most experienced pediatric neurosurgeons in Bangladesh, offers comprehensive care for all types of pediatric scalp injuries, ensuring proper evaluation, surgical repair (if needed), and neurological assessment to rule out associated intracranial trauma. What Are Scalp Hematomas? A scalp hematoma is a localized collection of blood under the scalp, typically resulting from blunt force trauma. Based on the depth and anatomical location, they are categorized as: Cephalohematoma – between the skull bone and periosteum Subgaleal Hematoma – beneath the aponeurotic layer (more serious) Subcutaneous Hematoma – within superficial layers of the skin While cephalohematomas are self-limiting, subgaleal hematomas can lead to significant blood loss in neonates and infants, and require urgent medical attention. What Are Scalp Lacerations? A scalp laceration is a cut or tear in the scalp, which may range from superficial to deep, involving skin, subcutaneous tissue, and sometimes the periosteum or skull bone. These injuries bleed profusely due to the rich vascular supply of the scalp and often require: Thorough wound cleaning and irrigation Surgical suturing or stapling Tetanus prophylaxis Antibiotic coverage In complex cases, especially with foreign body entry, scalp avulsion, or infection, surgical debridement and even plastic repair may be needed under general anesthesia. Common Causes in Bangladesh Children in both urban and rural areas in Bangladesh are at high risk of sustaining scalp injuries from: Falls from bed, stairs, rooftops, or trees Bicycle or rickshaw accidents Playground collisions or sports injuries Hit by falling objects (bricks, furniture, utensils) Assault or non-accidental injuries (including Shaken Baby Syndrome) Instrument delivery trauma in newborns In neonates, birth-related scalp injuries may result from vacuum extraction or forceps delivery, leading to cephalohematomas or subgaleal hemorrhage. Symptoms and Red Flags While many scalp injuries appear superficial, certain signs indicate the need for immediate neurosurgical evaluation: Large or expanding hematoma Drowsiness, vomiting, or seizures after trauma Persistent bleeding from scalp laceration Depressed skull fracture under hematoma Signs of increased intracranial pressure (bulging fontanelle, altered consciousness) Clear fluid leaking from ear or nose (CSF leak) History of high-velocity trauma or fall from height Diagnosis & Imaging Dr. Nafaur Rahman ensures a detailed neurological evaluation followed by appropriate imaging: Non-contrast CT scan of the head – to detect skull fractures, intracranial hemorrhage X-ray of the skull – for basic assessment of fracture Ultrasound (in neonates) – to assess hematoma volume and brain status through open fontanelle MRI Brain – for deep or persistent swelling, or suspected brain injury Treatment Approach by Dr. Md. Nafaur Rahman For Scalp Hematomas: Observation for small, uncomplicated hematomas Cold compress and analgesics in mild trauma Surgical drainage in case of large or infected hematomas Monitoring for signs of anemia or hypovolemia in neonates Management of associated skull fracture or hemorrhage For Scalp Lacerations: Local anesthesia or sedation for stitching Layered closure with absorbable sutures (deep) and non-absorbable (skin) Wound dressing and follow-up Plastic surgical referral in case of large or cosmetically sensitive injuries Post-operative care and scar management All cases are evaluated for potential underlying brain injury, especially when scalp injuries are extensive or recurrent. Complications if Left Untreated Infection leading to cellulitis or abscess Chronic hematoma formation Osteomyelitis of the skull Seizures or delayed neurological symptoms Scalp necrosis or unsightly scarring Missed skull fracture or intracranial hemorrhage Importance of Pediatric Neurosurgical Evaluation In Bangladesh, many parents treat scalp injuries at home or consult non-specialized practitioners, risking missed diagnoses. Any head injury in children, even if minor-looking, should be evaluated by a qualified pediatric neurosurgeon like Dr. Nafaur Rahman to prevent long-term complications and ensure proper healing. Why Choose Dr. Md. Nafaur Rahman? Expert in pediatric head trauma and scalp injury repair Performs advanced imaging and neurosurgical assessment Offers emergency care at National Institute of Neurosciences & Hospital (NINS) Provides child-friendly, scar-minimizing surgical techniques Multidisciplinary care with pediatricians, neurologists, plastic surgeons Appointment & Emergency Contact 📌 Dr. Md. Nafaur Rahman Assistant Professor, Department of Pediatric Neurosurgery, NINS Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 Serial and Emergency Contact: 📱 +8801912988182 | +8801607033535 🌐 Visit: www.neurosurgeonnafaur.com