To Gorpy regarding megasessions

[Jotronic]

Gorpy,

 

I wanted to take this into a new thread so that we don't hijack Slapshot's thread

 

You said...

 

"I have seen some very recent scars from mega session docs that I would not be happy with. One reputable doc commented on one case, "it looked pretty standard for such a large session"."

 

Can you elaborate more on this?

 

You also stated...

 

"I would also contend that mega session docs routinely push the envelope as far as strip width goes. You can argue that based on the skill and experience of the surgeon the risk is minimized. That might be a valid argument. It is all something to consider in a seemingly simple procedure."

 

It is something to consider, indeed. I'm curious about, I think you doc, offering 5000 grafts in two days vs. one. Can you comment on this?

 

Thanks for your time.

[Gorpy]

Hi Jotronic - First I would like to say that I have come to respect your knowledge and opinion. I don't want to get into a protracted argument with you. I will admit when I am wrong. And I will read with interest you response. (Cause I can always learn something . But keep in mind that if I am confused about something then so are many others.

 

Point one - From viewing some scars of patients with large sessions, it appears to me that a larger session produces a slightly larger scar (I'm mainly talking about width, but I'm not pleased with the extremely long scars either). Thus, my comment about not being happy with it. I could be wrong about this. Maybe it's just photographic differences, but that is what it appears to me. Especially when comparing with my scar. I did see a doctor comment on one scar saying it appeared to be pretty standard for such a large session. That would indicate to me that larger sessions produce larger scars. I'm not going to mention any names. People are free to do their own research.

 

Point 2 - It is true that my doc offers two day mega sessions. I don't work for her and I'm not excluding any mega session docs from my assumption. Although I don't think she "routinely" does large sessions. Only under special circumstances.

 

Let me re-phrase my entire original statement into a simple question and we can go from there:

 

Is there a relative increase in risk of a larger scar when taking an increasingly wider strip from the donar area?

 

If you were to graph this out it would look something like:

 

------------High

risk level

------------Med

 

------------Low

---------------------------------------

----------------.5cm 1cm 1.5cm 2cm ...

-----------------------Strip width

 

What would the line in this graph look like?

[tkerr22]

just from knowledge I have received, the larger width of a strip you take out the higher chance of a wider scar as the skin must stretch more. I'm not a doctor but have been told that by doctors.

[Jotronic]

Gorpy,

 

I appreciate the comments. What I am trying to do here is educate and share. That can only be accomplished with dialogue so here goes.

 

 

Point One.

 

The doctor you refer to and the patient you refer to are well known to me. Yes, the scar was average for a session of that size (5600 grafts). The measurement was 1 to 2mm in width. This was proven without any question via photographic evidence. 1 to 2mm is the holy grail for most clinics. It's being done with the large sessions. Are there other cases you are noting because you mentioned "some scars" denoting more than one.

 

Point 2

 

"...only under special circumstances". My point exactly. You don't see these huge sessions being performed on a daily basis. Five thousand is a reach because the average patient does not have the physiological characteristics to allow for this. However, techniques are utilized for these megasessions to significantly decrease the amount of tension on closure. Overall, the width is not so much of an issue because they really are not that much wider. As I said before, a

strip scar of 32x1 cm with average density of 85 per cm2 will yield about what you got, 2700 grafts. Add only a half centimeter and you will get 4000 grafts. The tension is negligible and a wider scar will not result.

 

Larger scars do not result from carefully executed mega sessions. They result from poor technique and the inability to identify the proper characteristics in the patient. This is eveidenced by the .5cm to 1cm scars I see all the time from 700 graft procedures performed in the past couple of years by other clinics.

[Gorpy]

Thanks for that info Jotronic. I think from a laymans point of view, there is a lack of understanding (especially on my part) of the actual tension in a strip closure. Is an extra .5cm or .8 really negligible? I'll take your word that in specific cases it is.

 

Wow. 32cm, that's 5cm longer than mine. It might sound silly, but I don't like those long scars. I would not want mine any longer (I wish it was shorter). I know, it's all covered by hair in the long run, but I still don't like it. There's something about it coming far around the sides that bothers me. Of course that's just a personal preference and has nothing to do with tension.

 

I think my original post was partly an emotional response to some of the small procedure bashing that takes place (if you can call 2500 to 3000+ small). So, once again Jotronic, you have educated me. Thanks for your input. The other guy I was referring to is irrelevant at this point. His scar looks exactly like the first guy.