Pre-made lateral incision technique versus "stick and place" technique

[N-6]

Can someone explain difference? Does one method give better yield than other? Which is more common?

 

Thanks.

[azn_guy]

Can you elaborate on what you mean by "stick and place"?

 

if you mean saggital incisions, then do a find for "lateral versus saggital"

 

the very best doctors predetermine which incision method to use on a case by case scenario

[TheEmperor]

I think the distinction is that in stick and place, the techs (not the doc) are making the majority of incisions right before they place the grafts.

 

The alternative is for the doc to make all the incisions by himself, and then have them filled by techs over the coming hours.

 

Do you trust the techs to control design, transection, and angulation?

[azn_guy]

if Emperor is correct, I personally would NOT trust the technicians with the control design and angulation of the slits

 

I leave that to the doctor

 

Transection is a BIG issue, remember the top docs here have probably done thousands of HT's meaning they really really have the experience. Last thing you want is to lose your existing hair, the whole point of this to prolong what you already have and add more, right?

[Megatron]

I don't know enough to say which technique is superior. However, I don't think it's correct to assume stick and place is inferior simply because the techs place the hairs instead of the doc. Firstlty, it doesn't make sense to have 1 person doing a job that requires 2-3 people to do. Secondly, placing thousands of grafts seems like a meticulous job requiring a certain skill set that very experienced techs may be better at than docs.

 

Stick & place still requires the doc to make all the important decisions like density, coverage area, hair direction etc. To me, it just seems to make more sense to have a doc focus on the plan and have others execute it as the doc supervises.

 

Also, the idea of placing the grafts immediately after the incision is made seems more logical than having thousands of pre-made incisions sitting idle for several hours.

 

I'm no doc so I have no idea what yields better end results. But, stick & place makes more logical sense to me.

[phil mascallpen]

When I think of the difference the main one would be that you always read about how the healing process in the slit acts as a glue to hold the graft in place. It would seem that a slit that has started, however slightly, this process is at an advantage against graft popping over a freshly made slit that is exuding blood. It also seems that stick and place is messier because of the continual bleeding which could also lead to more graft popping with less chance of seeing it quickly.

 

Another benefit of the doctor making slits is the repetitiveness would seem to help with consistent angulation. The only benefit I see of stick and place is as a time saver for the doctor.

[azn_guy]

I could be completely wrong (since I was drugged up), but I "believe" my doctor made all the incisions first, then the techs started placing the grafts in while he continued to make the incisions. After he was done with the incisions, he started to help graft placement.

 

Again, I was drugged out so I don't 100% remember

[Megatron]

phil, can you describe what a slit is? I thought the incisions were the same and we were just talking about when the grafts are placed. what am I missed?

[phil mascallpen]

Mega I'm using slit as a shorter version of recipient incision. We're on the same page.

[Bill - Seemiller]

N-6,

 

The "stick and place" technique describes the process in which the physician or technicians make a recipient site incision and then immediately place the graft into it. By placing grafts immediately into fresh incisions that have not had time to contract or coagulate, incisions can potentially be smaller relative to the size of the typical graft.

 

Pre-made incisions whether perpendicular (lateral/coronal) or paralel (sagital) are made by the physician first in a strategic and artistic pattern designed mimic nature.

 

In both techniques when done correctly, the depth and angle of the incision is controlled so the hairs will grow correctly in a pattern that mimics natural hair growth.

 

While the "stick and place" technique is less common, both Coalition members Dr. Limmer and Dr. Simmons use perform it regularly with excellent results. Likewise, dozens of leading physicians pre-make the incisions before transplanting the grafts with excellent results.

 

When selecting a physician, it's important to get to know each physician and their varying techniques. As a patient, you will ultimately have to decide what techniques and who you are most comfortable with and ultimately select a physician you connect with that consistently delivers excellent results.

 

All the Best,

 

Bill

[N-6]

I'm with Megatron (great name btw). It makes sense to me that stick and place would be the better technique because the grafts are placed immediately which can possibly do two things - one, not give the incision the opportunity to close (which would obviously prevent placement of the graft) and two, not allow a doc to miss an incision. Do you think these possibilities are greater with pre-made incisions?

[Cam Simmons MD ABHRS]

I think that Bill has answered this quite well.

 

It is difficult to compare these techniques. Each technique has its own advantages and disadvantages. There are many theoretical arguments why one method may be better than the other but they are not supported by real science. It would be difficult to do an accurate comparison study of the two techniques because each doctor is most comfortable with the method that he or she uses. If I did a comparison study I am quite sure I would get better results with stick-and-place than with pre-made incisions and if, for example, Drs. Hasson or Wong did a comparison study they would get better results with pre-made incisions than stick-and-place. Unless we both operated on the same patient at the same time (in our own offices), there would not be a real comparison. If done well, you can get excellent results with either technique. The best way to judge a technique is not by theoretical arguments but by the final results that are produced.

[Dr. Michael Beehner]

I agree totally with what Bill and Cam stated above. For myself, the one big advantage of the stick-and-place method, which I take advantage of in certain unique cases, is the fact that it allows the surgeon to make the SMALLEST possible incision to place the graft in. This is because, at the instant you withdraw the needle or slit blade, you are immediately placing the graft into the opening before any elastic recoil or shrinkage can occur at the site. The benefits of this fact are two: One, you do the least possible damage to the vascular system of the scalp because of the smaller sites ,and two, you can place grafts closer together, because the sites are smaller and more will fit into a cubic centimeter than with a slightly larger site.

The big problem with stick-and-place is that it is not possible for the surgeon to personally perform the whole operation due to the time factor (time the grafts are out of the body) and the fatigue/exhaustion factor. He would be there for 16 hours till the wee hours of the morning and a lot of the grafts wouldn't survive because of the time out of the body. So this task has to be delegated or shared with ones assistants. I use the stick-and-place method mostly in doing "focal" areas in which I want maximum density with minimal scalp vascularity damage, most commonly in the "frontal core" area just behind the central hairline. In a handful of cases in patients who I thought had poor blood supply to the scalp due to multiple past scalp reductions and transplant sessions, I have done the whole case with stick-and-place and one of my assistants who is skilled at this would work one side while I worked the other.

For most transplant cases, especially where a large area of the scalp is being transplanted, the preferred method of choice in my practice and in the majority of them, is to make the incision sites first and then fill them. With skilled placers, the slight shrinkage of the site is not a major factor. But for some practices who become very adept at it, as Dr. Simmons stated, the stick-and-place method can work very well on a regular basis.

A compromise to these two methods described above is what Dr. Jerry Cooley calls the "modified stick-and-place" method, in which the sites are pre-made and then a small slightly blunted needle (to avoid puncture accidents to staff) is placed into the pre-made site to slightly dilate and hold it open. As it is withdrawn, the FU graft is then placed.

Mike Beehner, M.D.

[N-6]

Thanks for your responses. Dr. Simmons and Dr. Beehner, its great to hear feedback from physicians on these technical issues. I, as a layperson, may have some information and an opinion but it is the physician with specialized training, knowledge and practice who can help prevent the spread of misinformation, thanks again.

[azn_guy]

A compromise to these two methods described above is what Dr. Jerry Cooley calls the "modified stick-and-place" method, in which the sites are pre-made and then a small slightly blunted needle (to avoid puncture accidents to staff) is placed into the pre-made site to slightly dilate and hold it open. As it is withdrawn, the FU graft is then placed.

 

Really? This is what Dr. Cooley does? I had no idea, I obviously didn't do my homework, thank god his method works.

 

Plus when you're drugged and they're working on your recipient area (and the fact that you cannot see what they are doing). who would have thought...