OVERVIEW

What is a scalp hematoma?

A scalp hematoma occurs when the scalp is injured without laceration, causing blood to accumulate beneath the scalp. It is usually caused by birth trauma or external injury ^[1,2]. Large hematomas are more difficult to absorb.

Scalp hematomas typically present with symptoms such as redness, swelling, pain, and a lump. They can be relieved through physical therapy, surgery, or medication.

What are the types of scalp hematoma?

Depending on the location of the hematoma, it can be classified into the following three types:

• Subcutaneous hematoma: Due to the presence of vertical fibrous septa in the subcutaneous tissue, this type of bleeding is localized with a small amount of blood accumulation.

• Subgaleal hematoma: This type involves loose, honeycomb-like tissue and is not restricted by cranial sutures, allowing the hematoma to spread across the entire head.

• Subperiosteal hematoma: This type is usually confined within the boundaries of the skull and does not cross the cranial sutures ^[1].

Are scalp hematomas common?

Scalp hematomas often occur in neonatal birth injuries and are a common condition in newborns and infants ^[2]. There is no specific incidence data available, as the occurrence rate is related to the level of obstetric care in hospitals.

SYMPTOMS

What are the manifestations of scalp hematoma?

• Hematoma: The scalp appears red, swollen, and slightly warmer than normal skin temperature.

• Lump: The blood clot may feel fluctuant and soft upon touch, with localized tenderness.

What serious consequences can scalp hematoma cause?

If a scalp hematoma is improperly managed or left untreated, it may lead to secondary infection or abscess. If the hematoma continues to expand, severe cases can result in hemorrhagic shock, endangering the patient's life ^[3,4].

Additionally, a scalp hematoma may ossify and harden, causing skull protrusion and deformation, which affects appearance ^[3].

CAUSES

What are the common causes of scalp hematoma?

• Birth trauma in newborns: Often caused by delivery or the use of forceps. The fetal coagulation system is not fully developed, and excessive compression of the head during passage through the birth canal can rupture blood vessels, leading to blood accumulation under the scalp and resulting in a scalp hematoma. Additionally, improper use of forceps during delivery may injure the newborn's scalp, also causing a scalp hematoma ^[3].

• Trauma: Accidental injuries such as blunt force or falls can cause bruising on the head, leading to a scalp hematoma.

DIAGNOSIS

Which department should I visit for scalp hematoma?

Neurosurgery, Pediatrics, Emergency Department.

How is scalp hematoma diagnosed?

Patients are usually asked about a history of trauma. A physical examination is conducted to preliminarily assess the head condition, combined with laboratory tests and CT scans to evaluate intracranial conditions, which can often confirm the diagnosis.

What tests are needed for scalp hematoma?

• Physical examination: Check the size, location, and hardness of the head lump, and whether symptoms such as fluctuation or softening upon touching the hematoma are present to preliminarily assess the condition.

• CT scan: Primarily to rule out intracranial abnormalities and observe bleeding conditions ^[3].

• Laboratory tests: Mainly include blood tests and inflammatory marker tests to assess the risk of shock and secondary infections.

• MRI scan: If the hematoma is difficult to resolve, a cranial MRI may be performed when necessary to rule out intracranial tumors or other lesions.

TREATMENT

Can Scalp Hematoma Heal on Its Own?

Generally, small subcutaneous hematomas can be absorbed naturally without special treatment. However, if the hematoma is large, medical attention should be sought promptly ^[4].

If systemic symptoms such as fever, restlessness, or convulsions occur, emergency medical care is necessary.

How Is Scalp Hematoma Treated?

• Physical Therapy

  Pressure Bandaging: Aims to accelerate hematoma absorption and promote healing. After injury, blood clots around the scalp should be cleaned promptly. It is recommended to disinfect with alcohol-free iodophor and apply sterile gauze for pressure bandaging. Replace the gauze once it dries to keep the wound clean ^[2]. However, pediatric patients may have low compliance during this process, making treatment difficult, so parental assistance is required.

• Surgical Treatment

  • Drainage: Performed under sterile conditions, the hematoma is aspirated via puncture, followed by sterile gauze dressing. Antibiotics may sometimes be administered to prevent infection ^[4].

  • Surgery: If the mass is too large for aspiration or the hematoma ossifies into a hard lump affecting appearance, surgical correction by a neurosurgeon is required ^[3].

• Medication

  • Antibiotics: Such as penicillin or amoxicillin ^[5], primarily used to control infection. Possible side effects include rash, nausea, vomiting, diarrhea, or local reactions like phlebitis. Contraindicated for those allergic to these drugs.

  • Vitamin K1 Injection: Administered intramuscularly to promote hematoma absorption ^[2].

DIET & LIFESTYLE

What are the precautions after treatment for scalp hematoma?

• Bed rest, ensure adequate sleep, avoid strenuous exercise to prevent wound reopening.
• Keep the wound dry and clean to avoid infection.
• Maintain a balanced diet with a mix of meat and vegetables. Eat more fruits and vegetables, such as apples and leafy greens, to supplement vitamins and avoid high-fat intake.
• If the wound feels uncomfortable, seek medical attention promptly and avoid self-treatment.

PREVENTION

How to prevent scalp hematoma?

• During pregnancy, expectant mothers should undergo regular prenatal check-ups at qualified hospitals to monitor fetal development and prevent conditions like oversized fetuses or abnormal fetal positions. If such conditions occur, prenatal preparations should be made under medical guidance.

• Implement safety precautions in daily life, avoid blunt objects, and ensure safety for elderly individuals and children to prevent falls.