Open Wound on the Head or Scalp

First aid for an open head wound

1. Check for danger signs first. If the person is unconscious, confused, vomiting, having a seizure or bleeding heavily, call 911 or your local emergency number. Do not move them if a neck injury is possible, for example after a fall from a height or a car crash.
2. Apply firm, direct pressure. Use a clean cloth, gauze or towel and press hard on the wound for 10 to 15 minutes. Do not lift it to check. If blood soaks through, add more cloth on top.
3. Be careful if the skull may be broken. If you feel a dent, bone edges or a soft area, press gently around the edges of the wound rather than directly on it.
4. Do not remove embedded objects. Pad around them and get emergency help.
5. Rinse once bleeding stops. Clean the wound with running tap water for a few minutes. Avoid hydrogen peroxide or alcohol, which damage tissue.
6. Cover it. Use a clean dressing. Hair can be gently held back with a clean band.
7. Watch the person for the next 24 hours for signs of brain injury, such as worsening headache, repeated vomiting or confusion.

Why scalp wounds bleed so much

The scalp has five layers and an unusually dense network of arteries. When it is cut, the vessels are held open by tough connective tissue, so they cannot narrow and seal off the way vessels elsewhere do. A small cut can soak a towel and look alarming. Firm pressure almost always controls it. Real blood loss danger comes from very large wounds, scalp tears in older people or children, and people taking blood thinners.

Types of head wounds

How a doctor treats an open scalp wound

Assessment

The doctor checks your level of alertness, pupils, memory and nerve function, then examines the wound with a gloved finger to feel for a skull fracture, debris or a tear in the tough layer beneath the scalp called the galea. A deep galeal tear may be stitched separately because it helps control bleeding and supports the forehead muscles.

Brain scan

A CT scan of the head is recommended if there are signs of brain injury or other risk factors: loss of consciousness, amnesia, vomiting, a dangerous mechanism such as a fall from height, age over 65, blood thinner use, or a suspected skull fracture. Decision rules used in emergency departments help avoid unnecessary scans in children and adults with minor injuries.

Closing the wound

• Staples: the most common choice for straight scalp cuts. Fast, strong and well hidden by hair.
• Stitches (sutures): used for the forehead, face, irregular wounds or flaps.
• Hair apposition technique: strands of hair on either side are twisted together and fixed with a drop of skin glue. It works well for short, straight cuts when hair is at least about 3 cm (1 in) long, and needs no removal.
• Skin glue: for small, low-tension cuts.

Wounds are usually closed within 12 to 24 hours because the scalp's good blood supply lowers infection risk. Heavily contaminated wounds or bites may be left partly open.

Tetanus and antibiotics

You will be offered a tetanus booster if your last shot was more than 5 years ago for a dirty wound, or 10 years for a clean one. Antibiotics are not routine. They are used for bites, heavily contaminated wounds, and open skull fractures.

Caring for a head wound at home

• Keep the dressing dry for the first 24 to 48 hours. After that you can usually shower and gently wash your hair with mild shampoo, letting water run over the wound.
• Pat dry. Do not soak in a bath or swim until it has healed.
• Avoid hair dye, hair dryers on high heat and tight hats over the wound until it closes.
• For pain, use acetaminophen (paracetamol). Ask your doctor before using ibuprofen or aspirin in the first day if bleeding was heavy. Follow the label dose.
• Return to have staples or stitches removed in 7 to 10 days for the scalp, or 3 to 5 days for the face.

Signs of infection

The scalp heals well and infection is uncommon, but watch for:

• redness spreading beyond the wound edges
• increasing pain, swelling or warmth after the second day
• pus or a bad smell
• fever over 38 °C (100.4 °F)
• red streaks or swollen glands in the neck or behind the ear

Get a wound with these signs checked promptly. See wound infection for more.

Can an open scalp wound cause a brain infection?

It is very rare. The skull is a strong barrier. Infection inside the head, such as meningitis or a brain abscess, is a risk mainly when a wound goes through the skull, as in an open or depressed skull fracture or a penetrating injury. In those cases, doctors give antibiotics and a neurosurgeon cleans the wound. A superficial scalp cut that is cleaned and closed does not spread infection to the brain.

Possible complications

• Concussion and brain injury: a concussion can happen with or without a wound. Bleeding inside the skull, such as a subdural hemorrhage, can appear hours to days later, especially in older adults and people on blood thinners.
• Hematoma under the scalp: a large, soft swelling may form and usually settles over 1 to 2 weeks.
• Scarring and hair loss: a thin line of hair loss along the scar is common. Most scars are hidden by hair.
• Retained debris: gravel or glass left in a wound can cause infection or pain. Tell your doctor if you feel something in the wound.

Sequelae of an open head wound

"Sequelae" means the after-effects of an injury. For most simple scalp lacerations there are none beyond a small scar. After a head injury with brain involvement, after-effects can include persistent headaches, dizziness, poor concentration and mood changes, sometimes called post-concussion syndrome. These usually improve over weeks to months. Get medical review if they are not improving. A more severe traumatic brain injury may need rehabilitation.

Frequently asked questions

What should I do with an open wound on my head?

Press firmly on it with a clean cloth for 10 to 15 minutes without lifting. Once the bleeding stops, rinse it with clean running water and cover it. Go to urgent care or the ER if it gapes, is longer than about 1 cm, or you have any head injury symptoms.

Does a scalp wound need stitches?

A scalp wound usually needs closing if the edges gape apart, it is deeper than the skin, it is longer than about 1 cm (0.5 in), or bleeding restarts. Scalp cuts are often closed with staples or by twisting hair across the wound and gluing it. Ideally this is done within 12 to 24 hours.

How long does an open scalp wound take to heal?

The skin surface closes within a few days, and staples or stitches are removed after 7 to 10 days. Full strength returns over several weeks, and the scar continues to fade for up to a year.

Can I wash my hair with an open wound on my head?

Usually after 24 to 48 hours, unless your doctor says otherwise. Let lukewarm water and mild shampoo run over the wound, avoid scrubbing, and pat it dry. Do not soak it in a bath or pool until it has fully healed.

Why does a small cut on my head bleed so much?

The scalp has a dense blood supply, and its blood vessels are held open by tough connective tissue, so they cannot narrow to stop bleeding. Firm, steady pressure for 10 to 15 minutes controls almost all scalp bleeding.

When is a head wound an emergency?

Call 911 or your local emergency number if there was loss of consciousness, confusion, repeated vomiting, a seizure, clear fluid from the nose or ears, a dent in the skull, or bleeding that will not stop with pressure. People on blood thinners and older adults should be checked after any significant head injury.