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Hair Today; Scalped Tomorrow: Massive Subgaleal Haematoma Following Sudden Hair Pulling in an Adolescent in the Absence of Haematological Abnormality or Skull Fracture

Edmondson, Sarah-Jayne MBChB (Hons); Ramman, Saif MSc; Hachach-Haram, Nadine MBBS; Bisarya, Kamal MBBS; Fu, Brian MBBS; Ong, Juling MD; Akhavani, Mo MD

Journal of Craniofacial Surgery: July 2016 - Volume 27 - Issue 5 - p 1261–1262
doi: 10.1097/SCS.0000000000002710
Clinical Studies

Subgaleal haematoma (SH) is a rare condition, most frequently observed in neonates as a complication of Ventouse-assisted delivery. There have been few patients reported beyond this period. Those that are present within the literature have typically resulted from significant blunt scalp trauma, with or without associated skull fracture. Those resulting secondary to relatively minor trauma, such as hair braiding or hair pulling, are rare but have been reported and are often associated with underlying haematological abnormalities or nonaccidental injury patients. Most patients resolve spontaneously and without complication. The authors report a rare patient of a delayed presentation of a massive SH in an adolescent following a seemingly innocuous episode of hair pulling whilst play-fighting, in the absence of any underlying haematological or anatomical abnormality. Due to the size of the SH and the appearance of large areas of calcification within the haematoma, early liaison with senior neuroradiologists and haematologists, to rule out underlying anatomical and haematological abnormalities, respectively, was essential to guide appropriate management. Our patient highlights the need for an awareness of the possible aetiologies of SH and the necessity of early active multidisciplinary team involvement in the management of such patients, which is critical to ensure optimum patient outcomes.

*Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London

Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, Chelsea, UK.

Address correspondence and reprint requests to Miss Sarah-Jayne Edmondson, MBChB (Hons), Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, London, NW3 2QG, UK; E-mail:

Received 26 August, 2015

Revised 8 February, 2016

Accepted 28 February, 2016

The authors report no conflicts of interest.

© 2016 by Mutaz B. Habal, MD.