Dressings on the scalp- a challenge!
Many of you are familiar with the challenge of keeping a dressing in place on the scalp. If the patient is bald, you can, of course, use a regular adhesive bandage. But most often, hair gets in the way – and even the oldest nursing home resident is a little vain and wants to keep as much as possible of their silky hair! A bandage with adhesive edges is useless in such cases.
In our own clinical practice, we most often encounter the following types of scalp wounds:
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Malignant wounds (especially basal cell carcinoma and squamous cell carcinoma), both before and after surgical treatment
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Actinic keratoses
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Burns
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Cuts or abrasions on the scalp after trauma
Recently, we had a patient with a challenging scalp wound, so we decided to research alternative bandaging options. Our favourite alternative for situations with larger dressings is the turban technique (nr. 7 on the list). Make sure to take a look at that and practice it with your colleagues. Here are all the alternatives we found and want to share with you:
1. Using Hair Clips to Secure Bandages
This is a very simple way to secure a bandage, especially in the middle of the scalp or further forward on the forehead. Depending on which type of hair clips are used, this can also work for relatively short hair. If clips are placed at the back of the head, as shown in the picture below, keep in mind that pressure marks may occur if the patient lies on their back!
copyright: Zhang et al; MDedge ( •https://blogs.the-hospitalist.org/content/affixing-scalp-dressing-hairpins)
2. Alternative Use of Hair Clips with Tape
It may not be easy to see the details in the picture below, but the method involves not fixing the bandage itself with clips. Instead, wider clips are used, onto which tape can be attached. Tape is then applied to both the bandage and the clip, so you can avoid sticking tape directly to the hair.
Copyright: •https://www.haodf.com/neirong/wenzhang/132335.html
3. Tying Over with Hair and Steri-Strips
This is a very simple method for keeping smaller bandages in place. This technique will obviously not work well with short, curly African hair.
Several strands of hair are placed over the bandage from all four sides, then secured on top with Steri-Strips. If adhesive remover is used, the Steri-Strips can easily be removed during dressing changes.
copyright: Yang et al. 2024 Acta Derm Venerol. •https://medicaljournalssweden.se/actadv/article/view/42129
4. Tying Over Using Only Hair
If the patient has long enough hair, strands can be tied together over the bandage to keep it in place. For example, start by tying strands from the right and left sides together, then place a layer of tape over this. Next, tie the strands from the front and back together and fix them again with tape. Naturally, care must be taken not to tie too tightly, as this will pull on the hair roots and cause pain!
Copyright Yang et al. 2024; IJDVL •https://ijdvl.com/cross-fixation-bandage-with-long-hair-on-scalp-wound-after-surgery/
5. Tying Over a Bolster Dressing
This is a standard method in plastic surgery, for example, to hold a skin graft in place. It is the most secure bandaging method because it stays firmly in place. The surgeon places multiple sutures around the defect or graft and ties them over a gauze pad. Ideally, the knots should be made so that the sutures can be untied and reused at the following dressing change. It is important not to tie the knots too tightly, as this can cause pain from skin tension!
Copyright left illustration: Gerard M. Doherty; McGraw-Hill Education. www acsessmedicine.com
copyright høyre bilde: Hyeon Jong et al. 2013; Archives of Plastic Surgery https://www.researchgate.net/publication/237014900_Redoable_Tie-Over_Dressing_Using_Multiple_Loop_Silk_Threads
6. Fixation with Net Stocking Material
This is a well-known technique, particularly useful when multiple dressings need to be held in place on the scalp and face. Note that there is a considerable difference in the quality of these materials – some types are softer than others. Don’t buy the cheapest one for this purpose! Below are two examples of how this can be applied.
Option A) below is useful when there are wounds on large areas of the scalp and face. In the example below, the patient has only dressings on the scalp, and it is unnecessary to cover the face with the netting. Many patients would find that uncomfortable. However, the illustrations clearly show how to make incisions for the openings of the nose, eyes, and ears for patients who require dressings over large areas of the head.
Option B) By clicking on the image below, you are linked to a YouTube video from Hartmann showing an alternative fixation method with an elastic netting. The video is in an Eastern European language, but it is very self-explanatory. Again, this type of fixation is helpful for patients who also need dressings on facial areas.
Copyright: Hartmann; •https://www.youtube.com/watch?v=xax9FB8cqb8
7. Turban Bandage
There are several methods for this as well, but we have chosen the one we think is the very best. The video below demonstrates a technique that creates a head covering that stays in place for several days. We recommend that everyone watch the video and practice the method—it requires just a little bit of training.
Copyright: Natalie May; Vimeo: https://vimeo.com/146754875
8. Soft and Comfortable Head Coverings
We must remember that sometimes we can keep a dressing in place simply with a snug, soft head covering that doesn’t feel tight. This is definitely the most fashionable option. You can place a non-adhesive dressing on the wound and use only the cap to keep it in place.
Tip: Hiking beanies are often very soft and fit snugly. White may be an impractical color for this purpose, but most models are also available in black or other darker colors. There are also head coverings designed for patients undergoing chemotherapy – these are often very soft and fit well, and can be used to hold a dressing in place. There are so many possibilities here —any headscarf could be used in many cases.
copyright: Left: www.sb-ko.de; Center: www.bjorndaeli.com; Right: www.ubuyghana.com; www.temu.com
Below is an inspirational YouTube video featuring head wrap styles for chemotherapy patients in South Africa. These techniques can also be used to keep a head dressing in place during wound care!