Author Affiliations: Northeast Ohio Medical University, Rootstown, Ohio (Mss Saraiya and Bukavina); Departments of Dermatology, University of Mississippi, Jackson (Dr Brodell), University of Rochester School of Medicine and Dentistry, Rochester, New York (Dr Brodell), and Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Bhatia).
Performing closures of scalp wounds can be challenging, especially when patients are unwilling to undergo hair clipping at the operative site.
A 60-year-old white man presented for removal of a 1.2-mm mobile, noninflamed keratinous cyst of the right scalp present for several weeks. It was tender when struck with a comb. Hair-bearing skin covered the cyst. The patient was anxious about having his hair clipped.
Lidocaine, 1%, with epinephrine was infiltrated into the surgical field of the unshaved scalp. A disposable 6-mm punch was used to create an opening to deliver the cyst. The cyst wall was freed with blunt dissection, and the entire cyst was delivered. The wound was closed with 2 interrupted 4-0 nylon sutures tied with an instrument in square knots to approximate the wound margins. The medical assistant held the tail of the suture and applied traction while presenting the dark-colored suture against the contrasting light-colored glove (Figure 1) (
Saraiya A, Bukavina L, Brodell RT, Bhatia AC. Assisted Instrument Tie to Close Scalp Wounds. JAMA Dermatol. 2013;149(1):115-116. doi:10.1001/jamadermatol.2013.1067