Suture/Simple/Double/Trichophytic closure. Which one is the best?

[Bruce65]

I was wondering if someone can briefly explain what closure technique is the best?

Based on the discussions that I read on this forum, it seems like the trichophytic closure is by far the best technique to cover the donor area and reduce the scar but this is true if you don't need to have additional hair transplant.

 

I also saw that there are surgeons like Dr. Feller, Dr. true and some other doctors that use staples or sutures or simple or double layer closures and I was curious to know if this is a personal choice or there is a specific reason to perform such techniques?

 

Thanks

Bruce

[Bruce65]

I was wondering if someone can briefly explain what closure technique is the best?

Based on the discussions that I read on this forum, it seems like the trichophytic closure is by far the best technique to cover the donor area and reduce the scar but this is true if you don't need to have additional hair transplant.

 

I also saw that there are surgeons like Dr. Feller, Dr. true and some other doctors that use staples or sutures or simple or double layer closures and I was curious to know if this is a personal choice or there is a specific reason to perform such techniques?

 

Thanks

Bruce

[PLEASE GROW PLEASE]

Tricho is always better on a virgin scalp and its the doctors personal choice. The most important thing to avoid a crappy noticable scar is go to a well experience surgeon.

The only thing worse then a bad transplant is a widescar where you have to wear a mullet

[Bill - Seemiller]

Bruce,

 

It will be interesting to see what kinds of responses you get since surgeons vary in opinion on this topic especially since often times techniques are adapted to fit a particular patient. I know some physicians prefer using the trichophytic closure technique for all surgeries where some only use it if it is their last surgery. Some prefer using sutures with a single layer while others prefer a double layer closure while yet others prefer staples, etc.

 

I hope a few surgeons will offer their input on this.

 

Bill

[Bruce65]

Thanks Bill,

I am also hoping that we can have some answers from surgeons so they can give their own opinions about their techniques and why they use a specific technique rather than another one.

[Pat - Community Publisher]

Excellent Question.

 

Having observed surgery at dozens of leading clinics, it is surprising that there is not one predominant school of thought on the optimal donor closure technique.

 

Some physicians argue that using internal sutures below the surface of the skin in the subcutaneous tissue will reduce the tension on the skin that is sutured by an external skin layer suture. This technique is typically referred to as a "double layer closure" and can be used with or without the trichophytic closure.

 

Typically the internal sutures are disolvable, while the external skin layer sutures need to be removed.

 

Other physicians argue that internal sutures should only be used when the donor area is particularly tight due to either low scalp laxity and or a wide strip being removed. They claim that internal sutures, which can take over a month to dissolve, can potentially create reactions or irritations, although very rare, under the scalp.

 

Other physicians choose to use staples rather than sutures because they believe that the staples are more secure and do not bind on the skin or strangulate the skin like sutures might.

 

As for the trichophytic closure, it is a nice final touch that can help disguise the final donor scar by having the hairs grow up and through the scarline. But if the scar is wider than pencil thin it really will have only marginal value. Thus it is no replacement for doing a fundamentally sound closure.

 

Some doctors opt not to perform a tricophytic closure when they expect the patient to do more sessions because they believe that that the tricophytic closure can result in follicles along the scarline becoming some what contorted, which can make them harder to trim into viable grafts.

 

At the upcoming annual ISHRS meeting of hair transplant physicians in September, the appropriate implementation of the trichophytic closure is a dedicated topic. It will be interesting to hear the pro and con debate.

 

Personally, having had both sutures and staples, and seen dozens of surgeries and results, I believe the double layer closure with tricophytic closure is optimal.

 

I've always been impressed at how easily the skin comes together with virtually no tension when underlying internal sutures are used. Thus there is virtually no binding or tension on the external sutures.

 

The underlying internal sutures also remain in place for much longer than ten day and thus minimize the danger of donor scar stretching. Sutures are also much more comfortable, especially during their removal, in my experience and from what I have heard from dozens of other patients.

 

A double layer suture with trichophytic closure takes the most time of any closure technique. But in my non MD opinion, it is the most comfortable and optimal closure technique for the patient.

[PLEASE GROW PLEASE]

Yes thanks Bill

[PLEASE GROW PLEASE]

A double layer suture with trichophytic closure takes the most time of any closure technique. But in my non MD opinion, it is the most comfortable and optimal closure technique for the patient

 

I agree 100% with that statement

[Bruce65]

Thanks Pat for the great summary about different techniques. It feels good to hear that these techniques can have great results if performed professionally by the surgeon.

I will opt for tricho closure for my final HT session.

thanks

[M&M]

That was a great question and a very detailed response from Pat, that although thorough, was easy to understand. I also hope that some doctors weigh in... Dr. Feller, Dr. Shapiro, Dr. Hasson, etc.

[DV8]

Excellent reply Pat. Thank you for sharing. I'm curious if you have any further reaction to this doctor who is mostly on the same page with you except for the double layer part: (link removed by moderator)

 

One final point to make that I just remembered: some physicians believe that you should close the incision in two layers, i.e., two suture layers, one dissolvable and one removable. I do not agree. My incision lines look very good with a single layer closure and the risk of a two layer closure is greatly diminished. Again from Hair Transplantation (4th Edition), "In addition, buried sutures may cause a tissue reaction that resembles an infection, which frightens patients, is annoying to treat, and usually produces worse than normal scars. Such suture reactions are uncommon and generally occur only at the buried knot, but if they are unnecessary in the first place, it seems unwise to add another possible complication to surgery."

Edited March 19, 2013 by TakingThePlunge