Hair Transplant Hemostasis
GARY S. HITZIG, M.D.,* JOHN P. SCHWINMNG, M.D., F.A.C.S.** ANT) SEYMOUR L. HANDLER, M.D.***
Methods
A total of 110 patients undergoing either hair transplant or scalp reduction surgery were studied. This included 63 transplant patients undergoing three separate transplant procedures and 47 scalp reduction patients undergoing one to two scalp reduction procedures. In each patient multiple sessions were needed for completion of the process. The different modalities of coagulation were utilized in the various different hair transplant or scalp reduction sessions on the same patient. Coagulation was provided by the following sources:
Bircher electrocoagulation (Bovie) using the groundplate, radiosurgical coagulation using an antenna plate (Ellman), and infrared coagulation using a 2-6-mm cap over the light source (Redfield Corporation). In addition to this, three patients with arterio-venous fistulas in the donor area were treated by infrared coagulation and no subcutaneous sutures whatsoever. In the case of arterio-venous fistulas, follow-ups for one week, two weeks, and four weeks were performed in these cases to assure complete healing. In the case of hair transplantation, infrared coagulation as well as all other forms of cauterization were required in the donor areas only. In the case of scalp reduction surgery, cauterization was required during the course of the entire procedure. In the case of scalp reduction surgery patients, different forms of cauterization were employed for the first one third, middle one third, and final one third of the scalp reduction wound, in order to compare cauterization ease and technique. In the case of transplants all patients underwent three separate transplantation procedures, each one utilizing a different form of cauterization for each procedure in the donor area.
Randomization in the case of transplants was performed by groups of 21 patients having a different cauterization technique during different transplant sessions; for example, 21 had infrared coagulation for the first session, electrocoagulation for the second, and radiosurgical coagulation for the third session. The 21 had a separate order of use of different coagulation modalities for each of their three sessions and were divided into electrocauterization, cauterization by IRC, or radiocauterization. (see Table 1).
All settings for the infrared coagulation were in 1.5-second bursts. All settings for the radiosurgical unit were at or near maximum strength after various lesser strengths were attempted. The same was true of the electrosurgical coagulation. Tips were cleaned for the electrosurgical and radiosurgical coagulation during the course of the procedure. This was rarely required with the IRC, but if necessary only required wiping with a piece of moist gauze. Results were assessed numerically in terms of successful initial coagulation with one burst of any modality receiving a grade of three, two bursts receiving a grade of two, multiple bursts receiving a grade of one, and unsatisfactory coagulation receiving a grade of zero. The results were tabulated in Table 2.
In all cases, the same experienced surgeons performed the procedures. In all cases as well, failure to coagulate was treated by either suture ligation or clamping and tying with 3-0 cat gut suture.
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.
Address reprint requests to:
Gary S. Hitzig, M.D.
165 N. Village Ave., Suite 128,
Rockville Centre, NY 11570
