Hair Transplant Hemostasis
GARY S. HITZIG, M.D.,* JOHN P. SCHWINMNG, M.D., F.A.C.S.** ANT) SEYMOUR L. HANDLER, M.D.***
Discussion
The infrared coagulator with its multiple-sized tips and pinpoint accuracy has proven to be superior, especially in a wet field, by providing excellent hemostasis during scalp reduction and hair transplantation surgery (Figures 2-4).
An additional advantage of the IRC is that it is not necessary to clean the tip during use, which was required during electro- and radiosurgical coagulation. In addition, no plates are needed to either ground or antenna-ground the patient. These plates are cumbersome and cause apprehension to the patient. Using the infrared coagulator, unlike many lasers and electrodesicators, does not release particulate matter of smoke into the air so smoke evacuation is not required, increasing safety for the staff. The infrared radiant light energy penetrates into the tissue where it is converted to heat resulting in a coagulative necrosis of only a specific point of the tissue, which is precisely determined by presetting the timer, minimizing tissue destruction in the areas that are coagulated. In all cases of follow-up, healing progressed with no effect on surrounding tissue or loss of surrounding hair follicles. This was especially true in arterio-venous flstula repair where, in prior methods of treating them, we had experienced scarring in the area of excision. Pain had also been a problem postoperatively in repair of arterio-venous fistulas. Neither scarring nor pain was found with the use of infrared coagulation in treating arterio-venous fistulas. The fact that the infrared energy from the light source is directed through a quartz glass light guide that is covered by a nonad]aerent contact tip was advantageous, especially in the wet field where just brief location of the cause or the source of the bleeding would allow us to press the guide against the area and cause coagulation, even through the wettest of fields. In addition there was no sticking of the guide to the tissue, thereby allowing us to move on to our next coagulation without stopping to scrape charred areas off of the tip of the IRC; we only occasionally needed to wipe the tip with a piece of moist gauze. In addition, because it is a contact situation, there is no deep penetration making the IRC safer than using a laser. We found with 1.5-second bursts the potential for scarring was essentially negligible. The authors, two of whom are surgically trained, have used infrared coagulation as well as the other forms of cauterization in various surgical modalities. The adaptation of the infrared coagulator to hair transplant and scalp reduction surgery has greatly increased the effectiveness of these procedures by decreasing the need for extensive suturing, suture ligation ties, and by allowing a clear field. Because the light guide of the IRC is thin and several inches long, extensive undermining can be safely performed during scalp reduction surgery, because any form of bleeding is easily stopped. Accuracy of distance is easily achieved with the contact tip as well. A sapphire tip proved to be quite beneficial in being able to absorb heat with minimum effect on the tip itself. The Teflon tips that we used were not quite as durable, lasting only one to two cases before needing replacement.
The infrared coagulator has proven to be an invaluable tool in hair transplantation and scalp reduction surgery. It is both user friendly and effective for hemostasis in these procedures. We found it, compared to other instruments, versatile, lightweight, and easily portable.
References
1.Colver GB: The infrared coagulator in dermatology. Dermatol CIin 7 (1): 155-167, January 1989.
2.Haycock AJ, Ashto RE: Treatment of amateur and professional tattoos with the infrared coagulator. J Dermatol Treat 4:37-39, 1993.
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Gary S. Hitzig, M.D.
165 N. Village Ave., Suite 128,
Rockville Centre, NY 11570
