Saturday, July 21, 2007

Why Are You Making Me Google Hair Apposition Technique? -- Part I

I’ve said it before, I am a comment reader. I read the comment section on every post on every medblog that I visit. There are some funny comments out there, e.g., Shadowfax explaining on Surgeonsblog why he isn’t a surgeon: “But somewhere around Hour 8, I realized that I just did not have the requisite attention span to do this type of thing. I actually caught myself thinking "Fuck it. Let's just close her up and see if she lives." And I knew that surgery was not going to be for me.”

But I’ve been a little disappointed and frustrated lately because y’all have left me hanging on a couple of medblogs. Not enough comments or discussion. I know, I should be grateful that y’all let a nosy layperson like me get a glimpse into your world. I understand you are busy. But you’ve spoiled me. And it's not like I became a medblog addict on my own. You lured me into your world and got me hooked.

Here is an example of what is causing my frustration. On her blog, Dr. Smak sent this question out:
. . . I got an ER report this week of a child with a scalp laceration that was repaired by braiding the hair over it to close the wound. Discharge instructions were "Remove braid in one week."

Is this legit? Is this a bladeless suturing technique that I'm too ignorant to know of? Or are they making this up?
Dr. Smak got two responses that said yes, this is legitimate technique known as hair apposition technique (“HAT”).

Okay, that might be enough for you medical types but I need more. There were no anecdotes or practical advice. There was no discussion on whether anyone actually does this. No one commented on whether this is a viable alternative to stitches or staples or glue. Would this mean you wouldn’t have to shave my head? Does it hurt more or less than the alternatives? What if you don’t braid but someone asked you to. Would you fix the rest of my hair to go with my new braided look? (I'm also curious about the "bladeless" thing, but I'll let that pass as something technical that I wouldn't understand.)

See what I mean? All of these unanswered questions. Y'all need to comment more on each other's blogs (okay, I realize that sounds funny coming from a notorious lurker, but I'm not medical so I have an excuse.) I know I'm asking a lot, but wouldn't you sleep better knowing that your readers got their medical information from you, rather than some quack they Googled up?

Also, when the doctors don't comment, I immediately wonder why and jump to the conclusion that there is some deep, dark reason behind it. Which brings me to Part II (to be posted later this week). I am wondering whether doctors chose not to respond to a question on a resident's blog because of the subject matter, or if they just didn't find it interesting.

(Yes, I realize y'all have lives and I need to get one too, but your medblogs are so informative and entertaining. Right now, my immediate goal is to fight the urge to go to Charity Doc's blog and leave a comment telling him to get off his lazy ass and start blogging again.)


frectis said...

Here is your anecdote: My sister as a kid fell and split her scalp open. My mom cleaned it and braided her hair and it healed up perfectly. She may have done that a couple of times for my sister, who when she fell preferred to do it head first.

make mine trauma said...

I'm no doctor but what if you are a boy with a buzz cut or a girl with short hair? Do you get free hair extensions first? I was at a hospital yesterday that actually has a beauty salon in it. Perhaps that is why.
As for "bladeless suturing technique", only thing I can think of is she meant to say needleless or she is referring to the fact that sometimes you have to trim up skin edges before you close them, although this is often done with scissors too.
I must say though, HAT makes sense but risk of infection may be a concern.

Anonymous said...

Hmmmm, when Little Joe split his head open in 1998, they used super glue and called it dermabond . . .

Anonymous said...

Oh, please, PLEASE talk Charity Doc into blogging again! If you do, I promise to comment all of his posts for a month. Seriously :P

Sid Schwab said...

The technique is described and used (I never have, but then again, I never shaved scalp lacerations to sew them up.) As to infection: because of its generous blood supply (bleeds like stink), scalp infections from lacerations are pretty uncommon. Plus, there's no reason you can't scrub it up before the braiding.

And, in order to make comments sufficiently entertaining for our host here: guy walks into a bar...

Anonymous said...

Well, I left one of the comments but all I know about it is that it exists. Never done it, never seen it done.

I'm pretty sure this is a viable alternative and would hurt less than staples. I know shaving is out, it's supposed to increase infection by driving bacteria into the wound. Cutting is ok.

And if someone asked me to braid, then I'd go look up how to do it and do my best. But no I'm not fixing the rest of your hair :)

Doc's Girl said...

I just wanted to let you know that there was a girl commenting on something in Cosmo (magazine) whose last name was Throckmorton.

I instantly thought of you. :) :)

I would love the link to the video clip you mentioned....:) It sounds hilarous!

Lynn Price said...

I'm with you, MBA, where the snot is Charity? Did those trade winds and coconut bras get the better of him?

Dr. Smak said...

Medblog Addict,

I agree with you. Most of the time the comments are the fudge filling of the proverbial blog donut.

Thanks for reading my blog.

Dr. Smak

PS You could comment a time or two.

PPS Yes, I meant needleless.

PPPS I bet the 14 year old candy stripers could close some pretty complex lacs given the opportunity. Their braiding skills are likely more advanced than the average ER doc.

Medblog Addict said...

Thanks for stopping by, and for your "entertaining" comments. Sometimes I feel guilty that I'm such a lurker.

I hope Charity comes back. I'd hate to lose another one.

10/10, I can't believe you'd let me walk out of the ER with bad hair. What kind of place are you running?

DG--I will try to leave the video in your comment section.

SeaSpray said...

Funny Doc's girl!

#1 Dinosaur said...

Guy walks into a bar...


Bongi said...

the scalp is a special place due to its very good blood supply and excelent venous drainage. you could literally spit in the wound and it will still probably heal (don't try this at home kids). to use hair or whatever to approximate the wound should work. i think the main problem would be that braiding is much less hemostatic than sutures.

the other point is, i understand that the therapeutic danger of shaving takes a while to manifest. i shave just before operating and i think the literature supports me there. to shave the previous day is now frowned upon. i would not hesitate to shave beautiful locks to suture a wound of the scalp. i personally would not braid, mainly due to hemostatic concerns.

ps. sorry about my serious comment. not my usual style, but i blame you because you asked.

Runs With Scissors said...

When I was a kid back in the 60's, I split my head open several times. Even way back then, my family's GP closed more than one of my head wounds by braiding my hair. This is the same guy that set my brother’s broken arm under hypnosis. In every instance, we healed just fine.

And, sorry, Bongi, but the literature doesn't support shaving of surgical sites anymore. See the IHI's SCIP (Surgical Care Improvement Project) info at: Shaving is out ... clipping is in.


Bongi said...

don't get me wrong. i am not a shaver (of patients. i actually almost daily shave myself) and the clipping thing makes good sense to me. but, even browsing that site, the difference in 1% and 2% in a poorly powered study does not convince. having said that conceptually the clipping idea does make sense to me. thank you

Sabra said...

I wish they had done this for my cousin when she got a gash in her head. It would have been much better than the staples.

Anonymous said...

I have done this several times. It works very well with children. They don't need anesthetics, there is no pain, they don't need to come back to remove the sutures, and it's costless.

Haven't reviewed the literature, though. ;-)

Norwegian surgeon