63.10 63.9 Controlling bleeding in head injuries

The scalp has an excellent blood supply from: (1) The temporal arteries ascending in front of the ears. (2) The supraorbital arteries which ascend over a patient’s forehead from the medial ends of his eyebrows. (3) The occipital arteries behind his mastoid processes. This excellent blood supply helps wounds to heal quickly, and maintains the circulation in skin flaps with a small base, but it does mean that a patient can quickly lose much blood from a scalp wound. Minimize this bleeding by making incisions from above downwards parallel to the main vessels, rather than across them, or round his head.

Controlling bleeding in head injuries can be difficult, and there are some useful special methods. You must have a sucker, and you will find diathermy useful. If you don’t have it, you will have to use a muscle patch to control venous bleeding. Don’t use diathermy superficial to the galea, and especially not on skin edges, or the small areas of necrosis it causes will prevent the skin healing by first intention. For the same reason, when you are operating deep to the galea, don’t let the diathermy electrode accidentally touch the haemostats on the skin edges.