so as to bring about the natural arrest of
haemorrhage, and it is difficult to apply forceps or ligatures to their
cut ends, suture ligatures are more efficient. On account of the free
arterial anastomosis in the deeper layers of the integument, large
flaps of scalp will survive when replaced, even if badly bruised and
torn, and it is never advisable to cut away any un-infected portion of
the scalp, however badly it may be lacerated or however narrow may be
the pedicle which unites it to the head.

_Gun-shot wounds_ of the scalp are usually associated with damage to
the skull and brain. A spent shot, however, may pierce the scalp, and
then, glancing off the bone, lodge in the soft parts.

_Complete Avulsion._--In women, the scalp is sometimes torn from the
cranium as a result of the hair being caught in revolving machinery.
The portion removed, as a rule, consists of integument and aponeurosis
with portions of muscle attached. In a few cases the pericranium also
has been torn away. So long as any attachment to the intact scalp
remains, the parts should be replaced, and, if asepsis is maintained,
a satisfactory result may be hoped for. When the scalp is entirely
separated, recourse must be had to skin-grafting.

_Treatment of recent Scalp Wounds._--To ensure asepsis, the hair
should be shaved from the area around the wound, and the part then
purified. Gross dirt ground into the edges of lacerated wounds is best
removed by paring with scissors. Undermined flaps must be further
opened up and drained--by counter-openings if necessary. When there is
reason to suspect their presence, foreign bodies should be sought for.
Bleeding is arrested by forci-pressure or by ligature; when, as is
often the case, these measures fail, the haemorrhage may be controlled
by passing a needle threaded with catgut through the scalp so as to
include the bleeding vessel. The wound is stitched with horse-hair or
silk, and, except in very small and superficial wounds, it is best to
allow for drainage. With the use of iodine as a disinfectant, it is
often advantageous to dispense with dressings altogether.

#Complications of Scalp Wounds.#--The most common complications are
those due to infection, which not only aggravates the local condition,
but is apt to lead to spreading cellulitis, osteomyelitis, meningitis,
or inflammation of the intra-cranial sinuses. These dangerous sequelae
are liable to follow infection of any scalp wound, but more espe