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Pitfalls with tricho closure


#1

The focus right now in our field is the donor area management .Follicular unit transplant seemed to answer the recipient dilemma.
Lately two techniques (FIT/FUE and TRICHO ) claimed to produce invisible scar to the naked eye in the donor.
A lot of ink went down to discuss problems arose from FUE such as white dots,thinning of donor if overharvest ,etc… What about the tricho?
I would like to illustrtate some problems with tricho based on two scar repair cases I had to treat in my clinic:

This 26 yo ,moving to a norwood 7 had a tricho closure and end up with this railway type of scar.(Side effects of all the strip if you tight strongly the stiches).You will also see hairs coming through the scar.(An advantage of tricho if the phenomenon is homogen through all the suture line).Not the case here.
There is also CHANGE IN HAIR DIRECTION as illustrated in the following microscopic pictures

Notice the different texture of the scar ,some area with no hairs and others with hairs in different direction.
This could create a superdensity zone that will appear ackward in some cases in you wear your hairs short or wet.
Our second case is a good example

This patient had widening of his scar by stretch back and it was his 3rd strip surgery.
While performing a tricho closure ,don’t neglect the precaution of a regular strip procedure.Otherwise you will loose all the advantages of this wonderfull technique .
as treatment we grafted BHT into the scar of the first patient.The second one had hairs removed in the scar by FIT and at the same time we changed the direction and reimplant them .We of course complete the grafting with BHT.


#2

drmwamba what exactly is tricho closure?


#3

» drmwamba what exactly is tricho closure?
trichophytic closure is a technique of closure where you trim off one edge of the strip wound and overlap it with the other one .When the scar will take place ,hairs from the under edge will grow through the scar and make it undetectable.
See also this link for more info http://www.bernsteinmedical.com/resources/trichophytic-summary.php


#4

» » drmwamba what exactly is tricho closure?
» trichophytic closure is a technique of closure where you trim off one edge
» of the strip wound and overlap it with the other one .When the scar will
» take place ,hairs from the under edge will grow through the scar and make
» it undetectable.
» See also this link for more info
» http://www.bernsteinmedical.com/resources/trichophytic-summary.php

It is still a strip, correct? why do people want to do it when there is FUE?


#5

» » » drmwamba what exactly is tricho closure?
» » trichophytic closure is a technique of closure where you trim off one
» edge
» » of the strip wound and overlap it with the other one .When the scar
» will
» » take place ,hairs from the under edge will grow through the scar and
» make
» » it undetectable.
» » See also this link for more info
» » http://www.bernsteinmedical.com/resources/trichophytic-summary.php
»
» It is still a strip, correct? why do people want to do it when there is
» FUE?

Because you will benefit from the advantages of strip such as low cost,speed , and non visible scar.It is one step ahead in the strip world.
Unfortunately the disadvantages or side effects are those of strip too.Therefore someone has to think twice before to jump on it .The safest way is to go with FUE/FIT.The Dr should examine the patient and determine what technique will answer the best to patient’s goals.