A 26-year-old man presents to urgent care with a 4-cm frontal scalp laceration sustained 2 hours prior. The wound does not violate muscle or tendon, but crosses the hairline and is oozing slightly, even after injection with 1% lidocaine with epinephrine. Which of the following options is best next step for management of this wound?
A. Close the wound using hair apposition for the hair-covered (top) portion of the wound and using tissue adhesive for the skin inferior to the hairline.
B. Close the wound using staples for the hair-covered (top) portion of the wound and using 6-0 polypropylene (Prolene®) sutures in a simple interrupted technique for the skin inferior to the hairline.
C. Cleanse the wound and advise the patient to return for possible delayed primary closure.
D. Staple the entire wound because it’s on the scalp and the whole scar will be covered by hair if the patient doesn’t trim his hair too short in the future.
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Answer: B. The best option for closure of this wound would be staples for the hair-covered (top) portion of the wound and simple interrupted sutures for the skin inferior to the hairline. Tissue adhesive is a poor choice for wounds that continue to ooze after anesthetic application. The wound is well within the window for primary closure, so delayed primary closure would result in unnecessary inconvenience to the patient and would be more likely to produce a suboptimal cosmetic result. The portion of the wound inferior to the hairline is located on the face; due to cosmetic concerns, staples are not appropriate for facial wounds.