Disaster: How many grafts will I lose if I have large dark blood spots after FUT?

[rsn]

The day after my FUT, the doctor said it does not look good. There are dark spots in the shaved recipient area. They look like bruises, like internal bleeding. (Not merely dots, but quarter size red areas.)

 

The doc said that means blood is not reaching the bruised looking areas, and I might not keep all the grafts. He said recipient areas take better during the first FUT, but the skin gets thicker after that.

 

He gave me an injection to help circulation. He said to take off the band that was holding a bandage over the donor scar because that will help circulation. He said to take aspirin too to help circulation.

 

How often does this happen? How bad is it?

 

He says he expects at least 80% of the grafts to hold, but would not get more specific.

[delancey]

Can you please post some pictures of the bruises with natural light?

[rsn]

Picture.

[GreatPelo]

I've had several FUT procedures and have never gone through this...so not sure I agree with your doctor saying FuT takes better on first procedure. I would absolutely be evaluated by a 2nd or 3rd doctor.

[rsn]

How bad does the picture look to you?

[delancey]

I am not a medical professional so I do not want to comment or speculate. Did the doctor mention anything specific as to what the dark spot/bruises may be?

 

Who was your doctor? If I were in your shoes, I would seek out a dermatologist immediately.

[GreatPelo]

You're probably going to be in a wait and see what happens. End results are a full year.

[rsn]

Dr. was Madhu. He is a dermatologist / hair transplanter. He said the dark spots mean that the blood is not circulating there. He said it is bad, but would not give exact numbers.

[delancey]

Did Dr. Madhu exclude the possibility of the dark spots being necrosis?

[rsn]

Well, he didn't exactly exclude necrosis. He did not mention necrosis at all. He said, with some confidence, that the dark spots are caused because blood is not circulating to there.

[mikeey]

I think Dr. Madhu is Recomended here for FUT , He is from India !!

[rsn]

Yes. Madhu is recommended here and in India.

 

My impression is he is conservative. First transplant with another doc 2 1/2 years ago was 2716 grafts. Skin felt very tight. Ears swelled. A lot of post surgery pain.

 

This time Madhu cut a second scar saying he can get more grafts that way. Zero tightness. He said he could only get 2308 grafts. (I would prefer tightness and more grafts.) He said he felt my skin does not have the laxity to ever get a third FUT again. I think this is also because he is conservative. He said in addition to little laxity, I have little laxity and only 65 grafts per centimeter density.

 

More than anything, I am worried about a low yield now because of the dark spots in the picture. And I am wondering if the dark spots have anything to do with India. There are a lot of germs here. Madhu said I have to boil water before shampooing with it because there is too much bacteria in local water.

[mikeey]

I hope everything is settled in future , Do not worry so much , You shall be fine

 

I really dunno much about India and its water Contamination , But it is True that Bacteria can and does cause a Lot of Harm to the Grafts and Hampers the Healing Process , so Please Boil as the Doctor as Instructed , I think you should be fine , A Minor Loss of grafts will Not effect the Overall Results . Take Care for atleast 10 days , as the grafts get secure !

[Noodles123]

Might be necrosis. I'd have this looked at immediately.

[rsn]

Might be necrosis. I'd have this looked at immediately.

 

Madhu looked at it. He said to mail him a picture every two days. The only remedial action he said to take is to swallow aspirin for circulation. Are you saying I should go to a different transplant doctor to look at it?

[bricvic]

rsn,

I think he's saying to go to ANY competent doctor to have this looked at, and he's right! I'm not trying to alarm you, but you really need to be proactive about this, especially if there's even a remote possibility that it can turn necrotic.

[KO]

Yeah, I think it might be necrosis.

 

Hair Loss InformationIs This Necrosis After My Hair Transplant? - Hair Loss Information - Balding Blog

[JoeTillman]

Necrosis is dead tissue so this is not necrosis, at least not yet. This is bad bruising and clotting but if it does not break up and dissipate soon it could turn into necrosis and then that is when trouble begins. Bruising like this happens when the patient's skin just can't the density. This does not mean high density as this can occur at moderate densities as well. This is one reason why no doctor can guarantee density without first seeing how the scalp reacts to the incision making process.

[Ali Emre Karadeniz]

That looks like venous congestion. This means that the veins that collect the deoxygenated blood can't work properly due to surgical damage to the venous vasculature, thus deoxygenated blood being accumulated within the superficial tissues. It is very rare in the scalp to see skin necrosis, because the arterial blood supply is excellent, however venous insufficiency can be seen. The skin usually heals without necrosis but the grafts may not get sufficient arterial supply in the first few days that are critical for them to survive until new arteries are produced.

 

In my opinion this complication is related with problems associated to the technique of recipient site incisions. Coronal incisions, especially when they are too wide, too deep or too close to each other may cause this complication. Another cause could be too much epinephrine injected, but this would most probably cause arterial insufficiency.

 

I don't know if there is a treatment but in general, circulation problems in microsurgery can be treated by aspirin, intravenous dextran 40, oral or intravenous pentoxifylline in the first 4-5 days to increase circulation. After that I think it is too late.

 

I am sorry about what happened, but at this stage the best thing is that your doctor follows it to rule out any skin necrosis and if that doesn't happen just forget about it and hope as many grafts as possible survive.

[rsn]

Wow, I'm in a great panic and depression. The blackness or internal bleeding has not diminished much at day 5. The tech's worked real fast. The entire surgery with 2300 grafts FUT took less than 3 hours. Dr. Madhu does several surgeries in one day, so maybe the tech's don't have long to do the implanting. Any guess from the picture how many grafts I will lose? I'm actually more worried about necrosis, which could be worse than going entirely bald.

[fisher4man]

Wow, I'm in a great panic and depression. The blackness or internal bleeding has not diminished much at day 5. The tech's worked real fast. The entire surgery with 2300 grafts FUT took less than 3 hours. Dr. Madhu does several surgeries in one day, so maybe the tech's don't have long to do the implanting. Any guess from the picture how many grafts I will lose? I'm actually more worried about necrosis, which could be worse than going entirely bald.

 

Panic and depression will not help you. Nothing can be done now, and if the grafts over this area are lost, it can be corrected later. I wish they all will survive.

 

I am not sure, but I think recommended surgeons here should do 1 or maximum 2 surgeries per day. So moderators should comment if Dr. Madhu really does several surgeries per day.

[rsn]

if the grafts over this area are lost, it can be corrected later.

 

I'm not sure you realize that the entire recipient area is blooded with some areas a complete pitch black and some areas more moderate in darkness. So when you say this area, you would be referring to the entire 2300 graft area.

 

And I don't have many grafts left to correct it. Dr. Madhu said I cannot have another FUT, and can get FUE for only 500 to 1,000 more grafts.

[options]

At this stage now, you should carry on taking the aspirin, and hope for the best. I know this is easy for me, or anyone else to say, but try and forget about it. Take some more pics in a week and then post them.

 

I wish you well and I hope for the best for you.

 

I'm not sure if what I've suggested above is medically acceptable, I'm just thinking about your state of mind. Could anyone advise now if he should seek medical advise? My understanding was that if there is some damage, it has been done now, and nothing can be done about it.

[hairweare]

I agree with Dr Emre's assessment. It is probably too late to try a more aggressive anticoagulant such as Lovenox or Eliquis. I doubt that the aspirin will be of much benefit at this point but it will do no harm. Please adhere to your doctors instructions and make sure to follow up in person when advised to do so.

[rsn]

Necrosis is dead tissue so this is not necrosis, at least not yet. This is bad bruising and clotting but if it does not break up and dissipate soon it could turn into necrosis and then that is when trouble begins. Bruising like this happens when the patient's skin just can't the density. This does not mean high density as this can occur at moderate densities as well. This is one reason why no doctor can guarantee density without first seeing how the scalp reacts to the incision making process.

 

 

 

I think I understand. Joe Tillman is saying that the standard of care is to try to implant with high density, while watching for blood bruising and clotting. And if bruising and clotting come, then pack less densely. In this way, you can avoid the massive blood clotting I had, which the veins could not manage to pump away to save the grafts.

 

As long as you aren't high speed densely packing without watching for blood clotting, you should not get the massive bleeding and graft loss I had. And as long as you watch for it, then generally the only other way you might get this massive bleeding is if the grafts are implanted badly as with sticking them in too deeply, as Dr. Karadeniz discusses above.

 

I don't even think I should bother to look if the massive bruises healed up. They did not by day 5, so the grafts are already dead.