UMEM Educational Pearls

It's back to school season which means back to school injuries! 

Scalp lacerations often require suturing or staple closure, but what if you can close the wound without any sharps that scare the kiddos? Consider using the Hair Apposition Technique (HAT)!

What is HAT?

- A very quick and easy technique for superficial scalp laceration closure made by twisting hair on each side of the laceration and sealing the twist with a small dot of glue for primary closure. 

When do I consider HAT?

- For linear, superficial lacerations that are <10cm in length 

- Laceration has achieved adequate hemostasis

- Patient has hair on both sides of the laceration

What are contraindications to HAT? 

- Hair strands are less than 3cm in length

- Laceration is longer than 10cm in length

- Active bleeding from laceration despite hair apposition

- Significant wound tension

- Laceration is highly contaminated

How do I perform HAT?

- Debride wound as you normally wound for any laceration  

- Take approximately 5 strands of hair on one side of the laceration and twist them together to make one twisted bundle

- Take approximately 5 strands of hair directly on the other side of the laceration and twist them together to make another twisted bundle

- Then take each bundle and intertwine the two bundles until the wound edges appose. 

- Place a drop of glue on the twist

- Repeat along the length of the laceration until laceration is closed

Benefits of HAT:

- Based on a RCT from Singapore that compared suturing to HAT for superficial scalp lacerations that were <10cm, patient's were more satisfied, had less scaring, lower pain scores, shorter procedure tiems, adn less wound breakdown in the HAT group compared to the sutured group. 

- A follow up study by the same group also assessed cost-effectievness of HAT compared to suturing (by taking into account staff time, need for staple/suture removal, treatment of complications, materials, etc) and found that HAT saved $28.50 USD when compared to suturing. 


Modified hair apposition of scalp wounds- UpToDate

Bottom Line:

- Consider Hair Apposition Technique (HAT) for linear, superficial scalp lacerations, especially in pediatric patients as it is much more well tolerated (can also do this in adults!)


Ong ME. “A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study).” Annals of Emergency Medicine. July 2002. 40:1. 19-26.

Ong ME. “Cost-effectiveness of hair apposition technique compared with standard suturing in scalp lacerations.” Annals of Emergency Medicine. 2005 Sept; 46(3):237-42.

Trick of the Trade: Hair apposition technique (HAT trick)- https:/