What happens when Donor Site Left "Open"?

[SFGiantsFan]

Had a hair transplant 11 days ago (strip procedure). ~5000 grafts, front to back, and the recipient site looks good.

However, I am second-guessing the procedure. Maybe it's just too early, but the donor site looks terrible. Ever since the procedure, I've had a wet, somewhat bloody pillow when I wake-up (even now). When my wife, who has been applying the ointment told me that the the scar looked wide (about half an inch) and looked "weepy," I called my HT office. This was around Day 5. They told me to take a picture, which I did. Got a call back from the receptionist who said that my HT surgeon said he had left the donor site "open" to relieve tension, and that it was not infected. Still, he gave me a prescription for more antibiotics.

When I went-in to have my sutures removed on Day 9, even the technician noticed that the donor wound was wide and went to ask another manager to take a look. At this point, I asked that the HT surgeon take a look, himself. When he did, he said that I was healing well! I was skeptical. When I expressed concern with the width of the donor scar, my HT surgeon said again that he elected to leave the left side of my donor site "loose and open" in order to "relieve tension," "to be safe," and "to prevent necrosis." He said that in a year's time, he could perform a scar revision surgery to reduce the width of the scar, at no additional cost.

I just had my wife take pics of the donor scar (Day 11). Looking at them (pictures below), I'm getting both more depressed and anxious. The wound on the left is wider than half an inch, and the wound on the right is more than a quarter of an inch. The entire donor site looks like an open wound, and nothing like the donor sites I've seen with the nice closed edges. Compounding all of this is the significant shock loss.

I'm really seeking for some support and advice. Clearly, this is not what a donor site typically looks like, even on Day 11, right? Has anyone experienced this, as a patient or as an HT surgeon? What is the prognosis?

[densedream]

WTF!!! You were butchered. Where was this and who is the "surgeon". I can't believe this is happening in 2015. If you live near a recommended doctor from this site, please go get a second opinion. Sorry man.

[Squatch]

Need to see a Doctor any Doctor now! Except the one that did that. This is what a scar looks like at 11 days.

Edited December 25, 2014 by Squatch

[harryforreal]

Was this the width of the suture at the time you left surgery?

 

I had a suspicious, deep mole removed on my back by a dermatologist and the sutures/stitches came out a bit early and the wound got wider. Luckily I had a doctor friend and asked her to look at it, and she said it looked infected because it was so wide and red and discolored. She told me to immediately go to to doctor to get antibiotics. As for the width, since it had already started to heal "open" there is now a "divit" in my back. When I asked about cutting it open and then restitching it closer together, I was told that in order to do that they would have to make an even larger cut, so it wasn't really worth it. With hair transplants, though, it seems "scar revisions" are quite common in capable surgeon hands. But I'm going to guess that that is the width that your scar is going to be without some type of revision.

 

All this being said, I agree with the other posters - you need to see another doctor immediately. Go to the emergency room of your local hospital - it looks that serious to me. What I learned from my doctor friend is that the open wound posed considerable risk of worsening infection. Worry about revision later on, focus now on your immediate health.

 

Sincerely,

 

Harry

[SFGiantsFan]

Yes, butchered is exactly what I feel it looks like, particularly in comparison to the pic you showed, Squatch. The HT WAS done by a recommended surgeon on this site. I'm not going to name him, though. As for the width of the suture at time I left for surgery, it was hard for me to tell. Certainly the right side felt "closed," the left side was left "loose" according to me HT surgeon. But I couldn't measure it. You've all pretty much affirmed that I'm looking at a pretty large scar, provided the wound heals. I continue on antibiotics, and will continue to monitor for infection. I'll also try to see another doctor. Given its Christmas today (this wasn't the present I had hoped it would be), it may be hard to find one today.

 

I will say, though, that the top of my head, the recipient site, looks good.

 

Thanks so much for responding, and happy holidays,

[JoeTillman]

SFgiants,

 

Would you mind giving some clarification? Are you saying that you walked out of the clinic completely unaware that you had an open donor wound and without proper post operative instructions that specifically addressed the issue and that the first mention of the wound purposely being left open wasn't until five days AFTER surgery?

 

To answer your specific question, what happens when a wound is left open, the area will heal fine as long as it is kept clean. Skin and scar tissue will fill the wound over the course of a few weeks and eventually, yes, the subsequent scar tissue can be removed via scar revision. Once it heals the appearance will be much less dramatic than it is now. You'll need to start loosening your scalp with stretching exercises at around the six to eight months mark depending on what your doctor recommends. I've seen this before and while it is not what you were expecting it can still turn out for the better in the long run.

[zyzz]

How could a recommended surgeon do that??

[Rawkerboi]

Oh man! A recommended surgeon did that?

Hard to believe

[densedream]

By not mentioning who it is, you are leaving all the people who read this website to possibly fall prey to this practice. That is exactly against what this forum is all about and defeats it's whole purpose. If it is somewhat common like he told you, he can come to this thread and clarify what the hell is going and why he had to do that to you. Do you think he will be angry that you posted here? He is a member and knows that all of his work can be scrutinised, which ultimately leads to a better choice of doctors.. Think about your fellow man.

Edited December 26, 2014 by densedream

[Rawkerboi]

Absolutely agreed with "densedream" mention the doctor name! A recommended surgeon leaving donor site open?

[1966kph]

Hello sf .

I sincerely hope your situation improves rapidly as this must of been a real worry for you and your poor wife having to put the ointment on.

Did the doc say what had gone wrong?

I am just presuming here that he got greedy with the size of the strip harvested and that any additional swelling has put to much pressure on.

To be honest I would not be happy at all.

Firstly I presume the final payable amount is determined by graft count and it seems his greed may have got the better of him and aimed for a unrealalistic size strip.

He has cocked it and offers a scar revision free of charge when you should not have needed one if he had just taken less of a strip.

You and your wife have had and still will continue to experience a lot of stress to get over this and then you will have more stress when it comes to the scar revision op.

I would personally want compensation for being put in a predicament such as yours as I think it was avoidable. Maybe I'm wrong and something else has caused this that has not come to light yet but one things for sure he has taken a descent size strip to get 5000 grafts.

Have you updates on your current condition I hope its at least healing well with no infection.

Did you travel for this or go to a localish doctor.

I think everyone reading through this thread will want to stay clear of this doc and I'm including myself in that.To send you home without informing you of the complications that had arrissen is UNBELIEVABLE. absolutely UNBELIEVABLE.

Nowadays we expect to go to a recomended top doc and get a procedure that leaves us with very little scarring but this is like going back in time to the 90's

I feel for you and I hope you heal as well as can be expected and from here on out everything goes smoothly for you.

Have a good day you deserve it.

All the best

[ej]

SF

I would go to your local Doctor and get this checked out asap.

 

ej

[zyzz]

Yes, get it checked asap. It concerns me that the doctor even states it is healing well when he well knows he messed up. I would be cautious of even letting him doing any further work or getting any revision to fix this. An emergency visit to top strip surgeon like Hassan/Wong should be your best option to fixing that if you want it done fast. (Given they aren't the Dr you visited)

 

Also, please state the doctor's name for the benefit of everyone including yourself.

[hairisimportant]

SF,

 

This is absolutely NOT how it should look like! Please do take care of it as there is high risk of infecting it! and PLEASE name the DOC as this is really disturbing!!

 

Hope you heal fast!

 

Cheers!

[delancey]

Did the OP mention that his surgeon is recommended here?

[1966kph]

Yes he did delancy.

[reflex]

SF,

 

 

I don't want to panic or depress you, but I need to be honest. That is a terrible result. You will need a scar revision(s) in the future. Unfortunately if there was a tension problem, your scar will stretch over the next 3 to 6 months. (My scar looked great for 2 months at 1 or 2mm, and then stretched to 6mm over then next 3 months.) And to be safe, you should not attempt a revision for about a year after it completely heals. Hopefully, you will be able cover it will your existing hair in the meantime.

 

You should find another doctor immediately for a second opinion about the wound.

 

I'm not accusing your doctor of incompetence, because it probably is an abnormal one off. But at the least, this appears to be a practitioner's mistake. You should demand a complete refund. This is an unacceptable outcome, not typical at all, and your doctor should eat the cost.

[Blake Bloxham]

Guys,

 

It doesn't even seem like this is a case of scar stretching. It sounds like the doctor tried to let the wound heal by "secondary intention." This is a medical term referring to the practice of leaving a wound open and letting it naturally re-epithelialize or close itself. It's something done frequently in infected wounds; it is not something usually done in hair transplant procedures. Obviously the post-operative shots are quite shocking and I will investigate this.

 

SF,

 

If you don't want to share information here, please send me a private message. I think this requires further investigation and an explanation from your doctor.

 

Thanks.

[densedream]

Guys,

 

It doesn't even seem like this is a case of scar stretching. It sounds like the doctor tried to let the wound heal by "secondary intention." This is a medical term referring to the practice of leaving a wound open and letting it naturally re-epithelialize or close itself. It's something done frequently in infected wounds; it is not something usually done in hair transplant procedures. Obviously the post-operative shots are quite shocking and I will investigate this.

 

SF,

 

If you don't want to share information here, please send me a private message. I think this requires further investigation and an explanation from your doctor.

 

Thanks.

 

Thanks Future Doc for stepping in here. I was hoping a moderator would say something and get to the bottom of this. I look forward to the explanation since I've never seen anything like it.

[1966kph]

What I find deplorable is the fact that the patient didn't get told anything about the complications.

As you say future this is deliberately done in the case of infection which is obviously not the case here.

To say patient care is lacking here is a under statement.

I'm sure the doc has had a nice Xmas with no money worries but this poor chap has been left to deal with this and having spent I guess a small fortune for the privilege.

Whatever the docs explanation the lack of aftercare,concern,compassion for the patient especially in the season of good will is disgraceful.

Complications happen any realist knows this and if they do you expect to be told,

I just find it unbelievable he was not told and the way he's been dealt with since should not be the way we are treated by a Dr that this community recommends other members or browsers to go to.

Shame on you doc who ever you are.

Have a good day all

[Bill - Seemiller]

Guys,

 

I agree that this needs further investigation ASAP. I would hope that the physician made clear the reasons why he left the donor wound open? If so, I ask that SFGiantsfan provides more detailed information on this. I'd also like to know the name of the surgeon so that I can contact him/her and investigate this fully. This is not something typical and requires serious attention and investigation.

 

SFGiantsFan,

 

If you'd rather not disclose the name of your surgeon publicly, please send me a private message or email me at help@hairtransplantnetwork.com ASAP.

 

Thank you,

 

Bill

[SFGiantsFan]

Dear All,

 

Again, thank you for the replies and expressions of concern. This experience has been difficult, to say the least. Before I attempt to provide more details to address some of your questions, let me just say that the donor site scar has improved significantly in just the past several days since posting. I've been reading a lot about the healing process and, quite simply, the body is amazing. Most of the scar is now slight pinkish and smooth, with the exception of what I refer to the problematic area on my left temple, which is still a bit raw (granulation tissue) but visibly getting better everyday. I'll try to post more pics.

 

To address some of your questions:

 

When I walked out of my HT, the entire donor site was sutured. I received the full complement of written post-op instructions about washing the recipient and donor sites, refraining from exercising, sleeping at a 45 degree angle, etc. The first several days, the HT clinic washed my head and applied ointment to my donor wound. Something I did not mention in my original post, but that my HT surgeon reminded me of, was on Day 2, when he checked on the donor site and asked how I felt, I told him I felt pain and tightness on the left site of my donor site. He felt the donor site on the left side, said some of the sutures were loose, but there was one on my left temple that felt tight, and he proceeded to cut it. At the time, I thought, "There must be a ton of sutures back there, so cutting one just helps to relieve some of the tension." And, I have to admit, it did feel better at the time. However, as I mentioned in my original post, it wasn't until around Day 5 that I learned that my HT surgeon, even though he sutured the entire donor area, and despite the suture he had cut on Day 2, left the sutures on the left side of my donor areas "loose." By loose, I mean that there was more slack than what normally sees in the closing of donor site.

 

I have to admit, when I saw the pictures I had posted of my donor site, I reacted like much of you. I expressed my extreme concern to my HR surgeon at the same time. He contacted me the next morning, Christmas morning in fact, and offered to meet with me today.

 

According to my HT surgeon, despite the large number of graphs, there was nothing pre-op or during the donor excision that had given him any indication that he would not be able to close the donor site normally. This was my first HT (virgin scalp and good donor site density). However, when he was attempting to close the donor wound, particularly on the left side, he noted quite a bit of tension -- he mentioned something about connective tissue. He said he could have closed it with more tension, but in his opinion, doing so risked cutting-off the blood supply to that part of the scalp, which could have resulted in necrosis. So, he elected to keep the sutures "loose," understanding that the donor wound would be wider than normal, but opting for safety instead. Now - and this is important - my HT surgeon told me that he had told me that this was what he had to do during the surgery, while he was suturing. I have no recollection of him telling me this, but I do recall when he was suturing my donor site him saying, "it's really tight on this side." I was heavily medicated during the surgery, so it's possible he told me about keeping the sutures loose on the left side and I just don't remember.

 

Now, I know many of you have asked for his name, and I apologize again but I cannot bring myself to do it, for several reasons:

 

1) I have worked in the surgical/medical field for all of my adult life. When I used to live in San Francisco, I worked for a prominent plastic surgeon. In LA, I worked for an internationally reknowned pediatric cardiothoracic surgeon. Even with the best pre-op plan, during surgery, sometimes surgeons are thrown a curve. The good surgeons have the experience to make the best, but sometimes difficult decisions when things don't go as planned. I believe this is what happened in my case.

 

2) I do not wish to engage my HT surgeon via this forum, nor do I believe he needs to justify his decisions to anyone but me. He has done so. While of course I am not happy with the current result, I would have been much less happy had I developed necrosis. He has offered to revise the scar for free; however, as some one mentioned, the scar needs time to heal. And, yes, I will getting second opinions on the revision, when it comes time. He has offered to meet and view my healing process as often as I feel necessary, weekly even (although that would be hard, given the travel). BTW, I'm not naive, it's in his best interest to provide me with the best outcome possible. He knows it, and I know it.

 

3) Now, to those who say, "Think of your fellow man," I totally understand. Looking at the pictures I posted, I'd be scared, too. But, I would also remind folks that, a HT transplant is not without any risks, and not all transplants have excellent results. As bad as those pictures were, I feel my ultimate result will be okay, with the exception of a 1.25cm wide x 5cm long scar on my left temple that I will hide when my hair grows-out, and that will will ultimately be surgically revised.

 

For those of you considering a HT, I would not let my experience dissuade you. I'm pretty sure the top of my scalp is going to look amazing, and the way I normally wear my hair, you won't be able to see the scars once my hair grows. However, if you are considering a strip procedure, I would suggest asking any HT surgeon you speak with, "Have you had situations when you either couldn't close a donor site completely, or there was a lot of tension when you attempted to do so? What did you do in those situations? What were the outcomes? What would happen, if that happened to me?" I did not ask these questions.

 

Again, thank you for your replies and I'm sorry again to those who will not be satisfied by my response.

[densedream]

Thanks for you detailed reply that tells more of the story. I still believe that some malpractice was involved because if the doctor took a smaller strip then the tension would have been less and the doctor could have closed the wound properly. A highly trained doctor that is recommended here should know almost exactly how much scalp to take when measuring the elasticity of the patient before the procedure. They should also take less that absolute maximum to guarantee they can close the wound properly. 5000 grafts has been done many times by a few doctors on this site such as Dr. Hasson and Wong, Rahal, and I'm not aware of many others. Dr. Hassan usually takes a longer strip to achieve such graft counts.

 

I hope you keep posting photos of the healing process of such a wound because it's not everyday this forum sees such a thing from a recommended doctor, I know you said you don't want to dissuade anyone from having a strip procedure, but I assure you that these photos will will send many people running towards a FUE. Your scar is most likely going to look atrocious. It also looks wider than 1.25cm. I would imagine it's not as easy to hide as you think, unless you wear your hair 3-4 inches on the sides. A scar revision is also not a guaranteed homerun procedure. Either way I wish you the best going forward. I hope you continue to update you progress.

[1966kph]

First and foremost SF is the excellent news your at least healing well now your health is the number one priority here.

I think and I may be wrong here but most strips are somewhere in the region of 1.25 cm x25-30 cm and your scar especially on the left isn't going to be far off those dimensions.

You have lost lasticity because of the strip removed already so like I say I'm not sure on this at all but he's going to have to remove the same size strip to remove the scar tissue and look at the problems he's had before the added loss of lasticity.

Did you have much swelling on your head (top,forehead) after the procedure?

It is obvious that if he had taken less of a strip you would not of had such a bad outcome as you are having to endure now.

And you stating that you were a bit out of it has just given the doc the excuse to say he said whatever to you but its just you dont recollect.

I am still of the opinion he has made a complete cockup of your closure and unless he takes a dramatically different approach with the scar revision closure your going to be in the same boat that you find yourself now.

I commend you on your loyalty to the doc by not mentioning who he is but I would definitely go to a different doc for the scar revision.

Ask your doc if he would object to you going elsewhere for the scar revision and if he would pick up the bill.

Glad things are looking up for you.

Have a nice day.

Edited December 28, 2014 by 1966kph

[ej]

SFG `s Doctor could of joined the thread and taken this opportunity to explain how this happened. I think that would of been the best way to proceed, surgery as we all know is not without its risks and complications, this thread could and may well yet become educational for those considering fut.

 

Going forward I wish SF all the best getting repaired, remember not to rush into anything, I found small improvements, maximum yield the way to go.

 

All the best.

 

ej