While on-call, I cover traumatic facial plastic surgery. Here's a patient that was cutting trees when a large branch fell on his head. No hard hat. Fortunate for him, he suffered no skull fractures. But, as you can see he avulsed a large portion of his scalp, down into the forehead. The ER called and said they had a hard time closing it because the edges wouldn't come together. I took him to the OR and cleaned out a large hematoma, controlled the bleeding and closed the wound. He has recovered well.