Trick of the Trade: Modified HAT trick revisited
I finally tried the Modified HAT (Hair Apposition Technique) trick for the closure of scalp lacerations. I have used the traditional HAT trick multiple times but not the modified technique.
What’s the difference?
Instead of using your fingers, the modified approach involves the use of two instrument clamps to help twist and pull the hair strands taut. It turns out that this makes a huge difference, especially for short hairs. The clamps allow you to grab the hair strands so much more securely, before instilling a tissue adhesive at the twisting points.
The nice added benefit was that my chubby fingers were now out of the procedural field. This allowed my assistant to more easily see and reach the hair twisting points with the Dermabond applicator.
Check out the finished product of this 2.5 cm laceration on the scalp vertex.
Bottom line
The simple addition of two instrument clamps provides significantly superior control, stronger tensile strength, and better exposure when twisting hair strands together. Try it.
From time to time, our patients need moderated and deep sedation in order to tolerate painful procedures such as joint reductions or incision and drainage procedures. There are many medications available to us including some newer ones such as Ketofol and Dexmedetomidine.
Have you heard of the Modified Centor Score for strep pharyngitis? Interestingly, it has been validated in adults and children. The methodology builds on the traditional Centor Score by incorporating the patient’s age, because this disease is more prevalent in kids than adults. In fact, you actually lose a scoring point if you are older than 44 years old.
