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Diiferent styles of the Strip Excision Closure... Hairtech


#1

Across the board this is yet another hot topic… Closing the strip excision. As far as technique goes eeeevvveryone is so different. I can only provide information for what I know in terms of the docs I worked for, however… I hope jotronic from H & W, vehement, B spot, HLC, gillinator, someone from Brad Wolf, MD because he has spoken to no end in the gold suturing at the ISHRS conferences. and patients all provide input here please… for the sake of the ghost readers out there wanting to know. It would at extremely interesting that posters take a picture of their suture line at whatever stage it is at and the tell us with a post how it was performed. This might not be an ideal thing but for those who wish to show themselves it would be treated with the deepest respect here. This is what I know of the different clinics.

Cooley: Tight continuous running suture/ blue nylon suture/upper ledge/ Ledge Closure/ sqweezes excess blood from the suture line and compressed bandage if leaky/ picks the suture line clean of hair while suturing/ uses Bovi for vessel cautery

Rose: Somewhat tight continuous running suture/ gut dissolvable suture/lower ledge/ Ledge Closure/ compressed bandage if leaky/ picks the suture line after suturing. uses Bovi for vessel cautery

Harris: slightly larger bites when using dissolvable sutures/tighter bites with nylon/Interrupted standard running suture X 2 sutures/Uses mosquito clamps for vessels/uses a modified towel clamp with gauze as a compression technique during suturing to help proximate the borders by descreasing fluid from tumescence/picks the suture line after suturing/neosporin

PAI: Wide bites with nylon single standard running suture/Uses an Infrared (Ir) Bovi for vessel cautery/ Picking???

Bosley: Wide standard running suture with gut dissolvable/band around head and especially on suture line until case over/no picking

Here is Dr. Roses words,

"I usually use a single layer running closure with a 4-0 nylon suture. I try to avoid having tension of on the wound edge. The sutures are placed close together to allow formore exact approximation of the wound edges.I rarely need to use a two layer closure with deep suture. When I do use a deep suture it is usually a slow absorbing suture such as PDS. At times I will use Vicryl. If I use a deep suture the sutures are intermittent and placed to take tension off of the tissue and avoid damage to hair follicles.
My ledge closure technique is often copied but not always well duplicated. I use a scalpel to score th lower edge and use a scapel to cut the epidermis at about 1mm depth. With this method there is higher degree of accuracy and the scalpel can be used to pick out the hair follicles to include or exclude. A true right angle is created like a cabinet joint.
I find that other physicians use a scissor and create a slope rather than a true ledge. This produces a less secure bond.
I also find that some physicians cut too deeply in trying to create the ledge.


Paul T Rose, MD
President ISHRS
2919 West Swann Ave
tampa, Florida 33609"


#2

Ha, I think you are barking up the wrong tree. Most of the folks here are anti-strip to begin with, you miight have a beter audience if you talk about fue donor sites, :ok:


#3

» Ha, I think you are barking up the wrong tree. Most of the folks here are
» anti-strip to begin with, you miight have a beter audience if you talk
» about fue donor sites, :ok:

Believe you me Froto I am Pro FUE to the max. You probably won’t find someone more pro FUE. I have to wait for a couple of days for my doctor. Then I will post more information in FUE science. Nevertheless, I cannot knock strip completely out because it is still strong.


#4

» Ha, I think you are barking up the wrong tree. Most of the folks here are
» anti-strip to begin with, you miight have a beter audience if you talk
» about fue donor sites, :ok:

Frodo is right, it’s all irrelevant how they suture up the donor, just get fue and you never have to deal with this ! who cares whether they use gold , silver or platinum in the sutures, irrelevant. IMO, they are still in the stone ages talking about how to suture up the donor. These docs should spend their time learning fue rather than reinventing the wheels, it is still a strip job any way you slice it.


#5

I reiterate my love for FUE… I promise. But since this is a site for discussion of hair transplant topics, this ine is interesting to those who partake. It is interesting since strip scars of the past forced surgeons to get better at closing strips.


#6

Ipod, it’s not totally irrelevant. If the strip docs can work with the Acell people, we can have unlimited donor supply, that’s hair multiplication my friend ! I dont know why people are not more excited about Acell.


#7

Well, unlike the other responses so far, I think this is excellent and something I have been trying to get from the board for ages. Thanks hairtec, it is so helpful having someone who is an expert and reviews all of the techniques where they come from and the options. This save a massive amount of research for those who want to be informed.

PLEASE PLEASE KEEP POSTING and pointing out the various aspects and parameters that we should be aware of.

My understanding is that the sutures are less important than the laxity induced by undermining.


#8

» Well, unlike the other responses so far, I think this is excellent and
» something I have been trying to get from the board for ages. Thanks
» hairtec, it is so helpful having someone who is an expert and reviews all
» of the techniques where they come from and the options. This save a
» massive amount of research for those who want to be informed.
»
» PLEASE PLEASE KEEP POSTING and pointing out the various aspects and
» parameters that we should be aware of.
»
» My understanding is that the sutures are less important than the laxity
» induced by undermining.

Thanks Marco… I wish Brad Wolf, MD would comment here. He is an expert and has done quite a bit of research into suturing especially with gold sutures.


#9

Good post.

Suturing technique does make a difference in terms of making a tight, clean closure. Also, I feel the various approaches to the tricho are of interest. I believe most docs trim the lower edge of the incision. Dr. Rose uses this approach and it work wonderfully with his Ledge closures.

Marco, you mentioned the importance of laxity in strip harvesting. One of the most significant factors with strip is closure tension. If the doc harvests a strip of the proper dimensions and closes the incision with little or no tension, a very faint scar should result.


#10

What types of exercises can promote good laxity pre-op? This will really be a good answer to help prospective strippers… no pun intended.:smiley: