Sublageal haematoma

sub-galeal haematoma describes bleeding in the potential space between the periosteum and the galea aponeurosis .It most commonly occurs after vacuum assisted delivery,but may also be seen following head trauma. In patients with intracranial haemorrhage or skull fractures,the incidence of subgaleal haemorrhageis increased.

Open head wounds
The first principlein an open head wound is thatwhat may look like a simplescalp wound may have a tear in the dura underneathit. The dura forms an excellentbarrier to infection,so thatwoundswhichgo through it are much more seriousthan thosewhichdo not. Even the mostseeminglytrivial head wound is potentially dangerous.If you neglecta wound of the dura, meningitis,a brain abscessor osteomyelitismay follow. X–rays are useful-much more so than in fracturesof the base. So X–ray all butthe mosttrivial open head injuriesin search of: (1) An open fractureundera penetratingwound. (2) A depressedfractureneeding elevation. (3) A spiculeof bone going throughthe dura whichneedsto be removed.(4) A foreign body. If you suspectthatany of thesefour thingsmightbe present,explorethe patient’sscalp rightdownto the bone.

Figure 63.12 : THE ANATOMY OF THE SCALP AND SOME IMPORTANT LESIONS. A patient’sepidermis(1) is separatedby a fibro–fatty layer of dermis(2), from his strongfibrous galea (3). These threelayers are firmly unitedto oneanother to form his scalp. Under his galea thereis a potentialspace,his subgalealspace (4), whichenableshis scalp to slide over his pericranium(5). Under his pericraniumlies his skull (6), his dura (7), his subdural space(S), his arachnoid(9) his subarachnoidspace(10), and his brain (11). When you anaesthetizea patient’sscalp, inject the solutioninto the fibro-fatty layer, notunderhis galea. Blood or pussometimescollectsin the subgalealspaceand spreadthroughit. An extradural haematomaforms betweenthe skull and dura, and a subdural onebetweenthe dura and the arachnoid.

ARE YOU SURETHEREIS NOPENETRATINGSKULLWOUND?

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