Weekly Article: HAT to Repair Scalp Lacerations

by Rasha Sawaya
The Hair Apposition Technique (HAT) for scalp lacerations, is the use of hair strands to close a scalp laceration: Twisting them and glueing them. I've talked about this technique with several of our PAs and NPs, as it seemed unknown. I've done it a few times in fellowship, it works quite well,  and I'm not sure why we don't use it more often, myself included. 

This article shows you how to do it- it's quite simple, tidy, and non-invasive! I apologize that it's a 2002 article, but I chose the original article for you. There's a modified HAT technique from 2008 -which is not really that different. (If anyone is interested, I can send it to you personally if you wish) As you can see from this RCT study: Patients who underwent HAT had less scarring (6.3% versus 20.4%; P=.005), fewer overall complications (7.3% versus 21.5%; P=.005), significantly lower pain scores (median 2 versus 4; P<.001), and shorter procedure times (median 5 ver- sus 15 minutes; P<.001. And it was at least a good as suturing for wound healing.  Moreover, later studies (2004) show it to be more cost effective than suturing or stapling (which makes sense, since the material and time used is less, and outcomes as good)!!

Has anyone else used this technique before? Thoughts?

If people are keen on this, maybe someone will be interested in introducing this technique to the team officially? We can do a short module to teach and then follow our performances and outcomes.... just a thought!

Abstract Ong Eng Hock et al. A Randomized Controlled Trial Comparing the Hair Apposition Technique With Tissue Glue to Standard Suturing in Scalp Lacerations (HAT Study). Ann Emer Med. 2002.

Study objective: We evaluate a new technique of treating scalp lacerations, the hair apposition technique (HAT). After standard cleaning procedures, hair on both sides of a laceration is apposed with a single twist. This is then held with tissue adhesives. HAT was compared with standard suturing in a multicenter, randomized, prospective trial.

Methods:  All linear lacerations of the scalp less than 10 cm long were included. Severely contaminated wounds, actively bleeding wounds, patients with hair strand length less than 3 cm, and hemodynamically unstable patients were excluded. Patients were randomized to receive either HAT or standard suturing, and the time to complete the wound repair was measured. All wounds were evaluated 7 days later in a nonblinded manner for satisfactory wound healing, scarring, and complications.

Results: There were 96 and 93 patients in the study and control groups, respectively. Wound healing trended toward being judged more satisfactory in the HAT group than standard suturing (100% versus 95.7%; P=.057; effect size 4.3%; 95% confidence inter- val 0.1% to 8.5%). Patients who underwent HAT had less scarring (6.3% versus 20.4%; P=.005), fewer overall complications (7.3% versus 21.5%; P=.005), significantly lower pain scores (median 2 versus 4; P<.001), and shorter procedure times (median 5 ver- sus 15 minutes; P<.001). There was a trend toward less wound breakdown in the HAT group (0% versus 4.3%; P=.057). When patients were asked whether they were will- ing to have HAT performed in the future, 84% responded yes, 1% responded no, and 15% were unsure.

Conclusion: HAT is equally acceptable and perhaps superior to standard suturing for closing suitable scalp lacerations. Advantages include fewer complications, a shorter procedure time, less pain, no need for shaving or removal of stitches, similar or superior wound healing, and high patient acceptance. HAT has become our tech- nique of choice for suitable scalp lacerations.