Tiny Tip: SCALP for the Layers of the Scalp

At some point during clinical teaching in emergency medicine, someone is likely to ask you about the layers of the scalp, and Rosen’s provides a helpful mnemonic for remembering them¹:

S – skin

C – connective tissue

A – aponeurosis

L – loose areolar tissue

P – periosteum

You may be asking yourself why you would need to know about the layers of the scalp. Isn’t this just the sort of trivia you cram into your cranial vault the day before an exam and then promptly forget?

Not so fast!

In the Emergency Department, the two layers that are helpful to know about are the aponeurosis and the loose areolar tissue layer. The aponeurosis anchors the scalp to the head. If this layer is breached by a laceration or cut, the wound will gape. Because of this, lacerations extending into the aponeurosis require suturing for optimal healing. The loose areolar layer contains emissary veins. When this area is breached, bacterial invaders can be carried into the cranial vault and cause serious infection.

So, next time your senior resident or attending asks you to rattle off the layers of the scalp as you’re gathering suturing supplies, remember SCALP.

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References:

Murray B, Cordle R. Pediatric Trauma. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Netherlands: Elsevier; 2017:2042-2057.

Reviewing with the Staff

This is, in my opinion, one of the best mnemonics in emergency medicine. The layers of the scalp are something that we rarely think about (unless we are examining a scalp laceration), is important to know for the reasons outlined by Dr. Luckett-Gatopolous, and is very simple and easy to remember (you really cannot get an easier to remember mnemonic!). Due to these features, it is often a question that is asked to medical students and junior residents. I would highly recommend that EM learners add this memory aid to their brain\'s armamentarium.