Hair Graft Survival out of the body

[waitforanagen]

Hi,

 

I am curious and somewhat concerned about something....

 

I am 4 weeks post op for a 3400 graft HT. I had 2 sessions of 1700 back to back (day apart). I'm norwood 6 and covered the top of head leaving the crown still bald (not that any of this is relevant to my question).

 

I was concerned during the procedure(s) how long my grafts were out side the body. Basically, the donor was harvested about 10AM and we didn't finish up until about 8PM or so each day.... so about 10 hours.

 

Of course they were being put in as we went so some were in within hours, others not so much.

 

I've read some studies on this that, as a rule of thumb, you lose about 1% per hour grafts are outside the body.

 

Just wondering if this long of a session (1700 each) lasting 10 hours is typical and should I be concerned about poor graft survival? The petri dishes were chilled and used some sort of special solution (not straight saline or ringers), can't remember what though.

 

I suspect I am a bit paranoid.... or maybe just looking for some reassurance :-)

 

Thanks,

[TakingThePlunge]

waitforanagen,

 

There are a number of factors that can affect graft survival rate out of the body. But, in general, 6 hours is normally considered the outside time limit for implantation if I'm not mistaken.

 

Chilling the grafts can increase the time limit as can the particular solution used. You may find the below article by Dr. Beehner encouraging.

 

The Best Graft Storage Solutions in Hair Transplantation

[Mickey85]

Big FUE sessions not yielding quite so well could be due to the grafts being outside the body for too long also. Some FUE surgeons extract 500 grafts then implant, then go back and extract more etc. Takes longer but the yield could be better?

[gillenator]

Time out of body definitely has an impact on graft survival. Some of the top FUE docs and even strip docs prepare the grafts in a cool solution that helps minimize the effects of ischemia reprofusion which in layman terms is deteriation and breakdown of blood infused body tissue. So this would also encompass body organs.

 

The quicker the grafts can be implanted back into the recipient area where the blood supply is, the better chances of survival and regrowth providing there have not been any other detrimental factors such as transection, traction, compression, and torsion effects which can occur during the extraction process, etc, etc. See below:

 

Transection - cutting and/or dissection defects

Traction - pulling force

Compression - sqeezing force

Torsion - twisting force

[Cant decide]

Assuming 6 hours is the rule of thumb, I wonder how some clinics can do huge sessions of 5000+. The grafts are all harvested at once in the beginning and some of these procedures can last over 10 hours. My final grafts I know were put in at least 8-10 hours after harvesting.

 

This is a good topic.

[waitforanagen]

Well, I guess I will find out in about 8 months or so.... I just was getting a bit worried at 6-8 hours. BTW I had FUT...

 

I guess it works as my surgeon is well known/respected and has been doing it for several decades now.

 

Since we worked from front to back, on pretty a much bald scalp; if the grafts died from being out of the body, I would expect to have denser graft survival on my hair line then thin out, then get denser and finally thin out as you go back..... as this mimics the implantation time on both days.

 

The other wild card in this (sure there are many others) is I was wondering how good of an idea it was to go back to back days. On the second day they injected my scalp with again an anaesthetic/vasoconstrictor... granted it wasn't directly in the same area but very close.

 

In retrospect I wouldn't think reducing blood flow in my scalp, just as the previous days grafts are trying to reestablish their blood supply, would be a good idea.

 

I've read grafts are pretty hardy so hopefully all goes well.

 

And, of course, my "concerns" are all speculation with no experience or a lick of science to back them up.... :-)

[SADbutTRUE]

i was just thinking the same thing today and was going to start a thread about this subject, maybe some of the patient reps can answer the questions, 1, do all ht clinics use the same soultion in storing grafts untill they get implanted, 2. is there different solutions used for fue cases then fut cases, because in fue cases one graft is taken at a time, where strip you get all of them at once . when the strip is cut out. is there any evidence that acell used as a grft storage medium helps with graft surival ? , thanks for any responses

[SADbutTRUE]

waitforanagen congrats on ur surgery , heal well and good growth to you,you had a strip case 3400, 1700 on one day and 1700 on another day ? i thought you had fue because you said your surgery was in two days, were you cut open 2 days in a row for strip, how did they close the wound the 1st day if they cut you open the 2nd day ? i never heard of this for strip.

[waitforanagen]

1700 on one day and 1700 on another day ? i thought you had fue because you said your surgery was in two days, were you cut open 2 days in a row for strip, how did they close the wound the 1st day if they cut you open the 2nd day ? i never heard of this for strip.

 

Yes about 1700 one day and 1700 the next. The harvest from one side, stitch you up (trichophytic closure).... then harvest from the other side the next day.

 

The harvest was not too big a deal other than having a wound run ear to ear and trying to find a way to sleep :-).

 

FUE was not an option for my NW 6 head :-). FUE is a waste for large areas, in my inexpert opinion.

 

Good news is I have good laxity and donor density and could do another 4000 if I wanted to - so the Dr says.....

[SADbutTRUE]

oh ok ,thanks for responding , heres to a hairy future

[waitforanagen]

Also curious if anyone knows an answer to this.... When the grafts were placed, the hair within them was trimmed short (obviously). So to look at me the hair looked like small stubble. Over the next 1-2 weeks the hair grew until it looked like a buzz cut, then most fell out. Though not all.... at 3 weeks when I had to return to work I cut them with an electric razor so it wouldn't look weird.

 

Is this an indication the grafts actually took? i.e. if a graft dies, does it continue to push out a hair and grow?

 

Just wondering if this is an indicator of graft survival.

 

 

Now if only this stupid redness / pinkness would go away :-) Hydrocortisone 2.5% is doing little......

[gillenator]

Yes by all indications, the grafts took. You are right on target for those "stubbles" to fall out. The reason they continued to grow immediately post-op was because they still remained in the growing phase (anagen), and then at roughly three weeks post-op they began to cycle into the resting phase (telogen) where they will remain dormant. After resting for approximately 3-4 months they will re-enter the growth phase again and you will begin to see the regrowth appearing above the scalp line.

 

The transplanted follicles re-enter the growth phase intermittently and that's why it takes up to one full year for the procedure to manifest itself completely. You should see lots of regrowth between the 4th and 6th month or so. Obviously there are some differences between patients, but those times frames are the average across most patients.

 

The best is yet to come my friend so enjoy your soon coming transformation!

[SADbutTRUE]

wouldnt it be great if the newly planted grafths never went into a dormant phase, that would be awsome, and grew once they were implanted.a dream for all ht patients.

[waitforanagen]

wouldnt it be great if the newly planted grafths never went into a dormant phase, that would be awsome, and grew once they were implanted.a dream for all ht patients.

 

Actually, I prefer them to go dormant. At least for me, with a very bald NW6 scalp, it looks quite weird to have a "buzzcut" look on top with a deep red scalp underneath.

 

I like the slow and more subtle approach... scalp goes back to normal complexion... and you look like you did before the procedure..... 2 -3 months later, some follicles start waking up and gradually growing thin hair that gets thicker as it grows longer.

[gillenator]

I also prefer a more subtle transition! :cool: