Head Wounds

Features of scalp wounds

Soft tissue injuries of the head carry a hidden threat. Due to anastomoses between superficial veins and intracranial vessels, local infection can penetrate the cranial cavity. This can provoke meningitis, encephalitis, or brain abscess, even if the cranial bones remain intact.

The arterial vessels of the scalp have a specific structure:

• They are located superficially.
• They are tightly fused with surrounding tissues.
• Do not spasm when damaged, causing bleeding to be prolonged, although the total volume of blood lost is usually small.

Classification of traumatic brain injury (TBI)

Skull injuries are divided into two main categories depending on the state of the aponeurosis:

1. Closed TBI — the cranial aponeurosis is undamaged, the internal environment remains hermetic. Meanwhile, soft tissues may be torn and bones fractured.
2. Open TBI — the integrity of the aponeurosis is compromised, creating a direct communication with the external environment. It is subdivided into:
3. Non-penetrating (dura mater is intact);
4. Penetrating (dura mater is damaged, intracranial contents are exposed).

Injury mechanisms and clinical presentation

By mechanism of impact, TBIs are classified as blunt or penetrating. Blunt trauma often occurs in motor vehicle accidents or falls.

• Direct impact (coup site): damages the cranial vault and brain tissue in the area of force application.
• Indirect effect (contre-coup injury): acceleration and rotational forces damage the parenchyma on the side opposite to the impact.

The main signs of TBI include general weakness, headache, dizziness, nausea, drowsiness, and loss of consciousness. A characteristic symptom is amnesia, which erases the circumstances of the injury itself and events preceding it from memory.

First aid rules

Competent first aid for head injuries helps prevent dangerous complications:

• The victim is placed on their back, constantly monitoring pulse and respiration.
• If the person is unconscious, they are turned onto their side to prevent tongue retraction and aspiration of vomitus.
• In closed wounds, the bandage is applied directly to the injury.
• In open TBI, the procedure is different: first, the edges of the wound are carefully encircled with bandages, and only then is the bandage itself applied to avoid pressure on exposed structures.

Class and exam questions

What else to study on this topic

• The role of computed tomography (CT) in the diagnosis of acute head injuries
• Diffuse axonal injury (DAI) in high-energy trauma
• Features of cerebrospinal fluid leakage and risks of pneumocephalus in penetrating wounds
• Diagnosis and clinical manifestations of cranial vault and skull base fractures
• Analysis of CT signs of subdural hematomas in coup and contre-coup sites

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.