Strip Scar with Tricho - Staples or Sutures???

[jzachery@hotmail.com]

which is better and why?

 

Also, would it be smart to have the doc save about 500 hairs from the strip and put them back into the scar during the surgery? Anyone do this?

[El Nino]

I'm not sure one is better than the other with regards to producing a thin scar. But sutures are a lot more comfortable and easier to take out.

 

It is not possible for hairs to be planted into the scar straight away, but it can be done via FUE when it has healed.

[Dr. Glenn Charles]

If performed properly you should have a hard time finding the scar once full healing has occurred. Therefore doing transplants on the same day into the area where the strip is taken from makes no sense. In the right hands a similar result can be obtained when using either staples or sutures. I agree that sutures are usually not as uncomfortable as staples.

[jzachery@hotmail.com]

But there isn't a difference in that staples keep the scar closed tighter or anything, or prevents stretching more than sutures?

[Dr. Scott Alexander MD]

This is an interesting question. As is everything in surgery, if sutures or staples are done poorly they both give bad results. Likewise if they are both done well, the results should be equal. The problem I see with staples is that most doctors do them not because they are better, but because they are easier and faster.

I prefer using sutures because I am able to get the tissue to approximate perfectly every time which is the most important step in quality wound healing. One thing you do need to be careful with suturing is that you cannot pull the suture too tight or it can cause strangulation of hair follicles and actually decrease blood flow to the area. You can see why skill is always an important aspect in receiving good scars.

If you leave the sutures in past 7-8 days, you have a good chance of causing "rail road tracks" or cross-hatching to form.

In stapling it's hard to make them too tight because the tension is set automatically by the staple and can't be altered. It is very easy to have your incision over lap if the edges aren't aligned perfectly. These too must be removed within 7-8 days.

Trychophytic closure would aide in giving optimal results in either of these closures. You just need to be sure that you have enough elasticity in the scalp to do it.

[Dr. William Lindsey]

I agree with Dr. Alexander who is right on the money as usual.

 

First, poor technique with either method will result in bad scars. Good technique with either will likely result in a good scar. I suture unless the patient requests otherwise--mainly because since 2000, I calculate that I have put in over 600k sutures, and maybe 2k of staples.

 

Second, either technique should be removed around day 7 to prevent railroad tracks.

 

Third, planting hair into a scar...in my opinion, leads to variable success. I just saw yesterday a fellow from the UK that I did FUE on last year. Once I edit the pics I will post. The bottom line though is that the FUE into scalp worked PERFECTLY while I would guess that he has 50% growth of the small FUE "trial" into his hypertrophic scar. I will put up the pics this week, but again, I usually favor scar excision over grafts into scar tissue.

 

Dr. Lindsey McLean VA

[TC17]

Dr. Lindsey,

 

Does performing a scar excision decrease the availability of grafts via strip method later? Wouldn't it tighten the scalp somewhat?

[Dr. William Lindsey]

TC17,

 

Depends on the case. For example, if you have done some scalp exercises and aren't really tight, we just excise the scar, not the scar and normal scalp. Now I am sure that we will get a few follicles along the edge, no doubt about that. But it shouldn't be many. More importantly, if you are a bad scar former the first time, and you get a good scar from a revision, are you going to chance another transplant widening out a good scar? That is the question the patient has to figure out. All depends on scalp laxity and the ability to get a tension free closure in my mind.

 

Dr. Lindsey