In late March as I was preparing to speak on medical preparedness at a conference in Utah, I came across yet another method for closing wounds that didn’t rely on using sutures. And I immediately fell in love with it. Weird. Yes, I am.
It’s called the Hair Apposition Technique, or as some say, the HAT trick. A previous blog post mentioned braiding hair across a scalp laceration. That only works with fairly long hair. With the HAT, much shorter hair can be used, though it won’t work on someone with a recent buzz cut. It will work with hairy arms and legs.
Step by step instructions for performing
the HAT trick:
1. Find a patient with a scalp laceration less than 4” long and no underlying tissue involved.
2. Irrigate the wound. Be sure the wound is perfectly cleaned out.
3. Stop all the bleeding. The scalp has a rich blood supply and this may take time and lots of pressure.
4. Ensure that the edges will align well without significant tension.
5. Take about 5 strands of hair from each side of the laceration. Twist each into a tight bundle.
6. Take the two twisted bundles and twist them together over the laceration. As you twist, the wound edges will draw closer together.
7. Apply tissue adhesive to secure hair bundles while the laceration heals. Physicians use DermaBond, very expensive stuff. Well-prepared folks use VetBond, less expensive stuff. One doctor indicated that liquid bandage may work. People up a creek without a paddle may use superglue. Be sure not to get it in the wound or on the skin.
8. Repeat across the entire length of the wound.
In case that wasn’t clear, here’s a link to a quick video: https://videos.files.wordpress.com/4H47OyPj/hair-apposition-web_hd.mp4
Aftercare for HAT tricks:
Monitor for any signs of infection.
Don’t pull the hair. Avoid combing or bushing the hair near the wound for 1 week.
Don’t wash the hair for 48 hours.
The glue will break down within a 7-10 days.
Do not use the HAT trick with the following:
Lacerations longer than 4”
Grossly contaminated wounds
Uncontrolled bleeding
Significant wound tension
I understand why it wouldn’t be used for wounds with too much tension. I don’t understand the reasons for the other three and could not find any information why. Maybe there is the concern about hair harboring microbes. But everything should have been washed well prior to closing. Uncontrolled bleeding always has to be controlled first, no matter what, so I don’t understand that either.
The doctors and nurses all say the best thing about the HAT trick is that there’s no need to return for staple or suture removal. The glue will naturally dissolve within 7-10 days as the wound heals. I have several other reasons for loving it:
Cheap. As Bob Barker used to say, “The price is right.”
Supply chain. Unlike our sutures and staples, it doesn’t come from China.
Pain free. It doesn’t inflict pain or require anesthesia.
Quick. It doesn’t require any particular skill.
Links to related posts:
References:
https://lacerationrepair.com/techniques/alternative-wound-closure/hair-apposition-technique/
https://em.umaryland.edu/educational_pearls/4266/
https://pubmed.ncbi.nlm.nih.gov/18410811/
Not exactly, the liquid bandage creates a film over the wound to keep stuff out. The wound glue or vetbond are design with a higher shear strength, you can hold a wound close and the glue will keep it closed, if you used the liquid bandages it would likely reopen unless you used another means to keep it closed. You can get vetbond on amazon cheaply.
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