Evaluation of Scalp Lacerations due to Ghamme-zani' (Slashing the Head with Blades) and their Treatment in Ashoura Ceremony in Karbala (2004)

Aims. Self-infliction by slashing the head with blades, albeit now treated as taboo by many religious authorities and their followers, is historical heritage for Shite Muslims in Ashoura ceremony and is therefore still practiced sporadically. This study aims at describing various types of scalp laceration and their treatment for physicians unfamiliar with the management of this rare multiple injury. Methods. We descriptively compiled data on 103 consecutive Iranian adult pilgrims to Karbala, Iraq who were referred to an Iranian emergency field unit over a two-hour period. Evaluation was conducted in terms of age, place of birth, wound depth and length, severity of bleeding and treatment modalities. Results. The mean age of the injured was 33.49 (± 1.03). A large proportion of them spoke the Azari language (62.2%), but the rest were from Isfahan, Qum, Tehran, and Arabic speaking parts of Iran. Sagittal (64 %) and transverse (36 %) lacerations were the main types of injury. Of the 103 patients, 16.5 % had mild bleeding 63% had moderate bleeding and severe bleeding was observed in16.5 %. 5.8 % needed serum therapy. The mean sagittal and transverse laceration lengths were 62.97 and 74.24 cm, respectively. Only 15 patients had their cuts sutured 84.9 % of the cases did not consent to being sutured as a result, the bleeding was staunched after the application of physiological saline and compressive dressing. There was a significant correlation between the number of lacerations and the wound depths (p< 0.047), as well as between the wound depths and the types of laceration (sagittal or transverse) (p< 0.03). In addition, there was a significant relationship between the wound depths and severity of bleeding (p<0.0001) and between the types of laceration and severity of bleeding (p<0.0001). The severity of bleeding and the depth of wound in transverse lacerations were higher. Conclusion. When there is a mass reference of those suffering from the aforementioned head lacerations, triage principles must be adhered to. Consequently, those bearing a greater number of deep transverse cuts must be given the priority as they seem to be more prone to profuse bleeding. Suturing followed by prophylactic antibiotics aimed at preventing tetanus is highly recommended. On follow-ups, the possibility of such diseases as hepatitis should be taken into account.