DS12 The scalp staple sandwich: a surgical pearl for secondary intention scalp wounds

Abstract

Surgical defects on the scalp may often be left to heal by secondary intention. When managing secondary intention wounds, the use of hydrocolloid dressings to promote granulation is well established. However, such dressings promote exudate formation, necessitating frequent dressing changes. Due to the nature of hair-bearing skin, the application of any such dressing at this location is problematic. Patients often find ‘head wraps’ uncomfortable and socially embarrassing. For 14 years, we have been implementing a rapid, efficient and aesthetically acceptable method of dressing wounds on the scalp, in what we have termed the ‘scalp staple sandwich’. Local anaesthetic is infiltrated around the edges of the surgical wound. An antibiotic or petroleum-based ointment is placed generously in the centre of the wound to minimize the risk of cortical desiccation necrosis if calvarium is exposed. A hydrocolloid dressing is then sized and placed directly over the wound, extending 5–10 mm beyond the edges of the wound itself. Skin staples are then used to secure this hydrocolloid dressing in place. In anticipation of the exudate that is produced in such wounds, an alginate dressing is placed directly on top of this hydrocolloid dressing, again ensuring that the edges of this dressing overlap the hydrocolloid dressing underneath. A nonadherent dressing is cut to shape and placed directly on top of the alginate dressing. This final dressing is then also stapled into place. We review patients with such wounds on a weekly basis. Patient-reported outcome measures regarding the scalp staple sandwich have been universally favourable in terms of comfort, aesthetic acceptability and at-home wound management. The need for local anaesthetic infiltration at each dressing change is the only drawback of this technique in our opinion. The scalp staple sandwich is a rapid, practical, well-tolerated and cosmetically acceptable method of dressing secondary intention wounds on the scalp.