For all scalp lacerations, begin with obtaining hemostasis and evaluate for complications such as foreign bodies, underlying skull fractures or galeal injury. The galea aponeurotica (or “galea” for short) is a dense white layer of fibrous tissue that covers the periosteum of the skull and serves as an insertion point for the frontalis and occipitalis muscles.
Left unrepaired, deep scalp lacerations with galea involvement (larger than 0.5cm) can result in subgaleal hematomas, infections, and poor cosmetic outcomes related to asymmetric facial muscle movements.
The technique for galea repair is identical to simple interrupted dermal sutures (or deep sutures).
Enter from deep to superficial coming from underneath the galea, exiting above the galea
Rearm the needle driver
On the opposite side, enter from superficial to deep, exiting underneath the galea layer