Stick and Place vs Pre-made slits

[anker21]

Is it true that stick and place has greater benefits over pre-made slits. I've heard the stick and place allows for more dense packing as the slits are smaller and cause less trauma to surrounding hair and blood supply.

[LaserCap]

There is always a better mouse trap.  Or is there?

For years doctors did MPRs..Then came the plugs.  Then came mini-grafts, Follicular unit transplants, and now the semi-automatic/robotic.  Making slits has been proven to work and doctors are now getting creative.  Where I used to think it was a requirement to do multiple procedures to achieve density, now I find some truly innovative techniques that allow for a much fuller look in a single procedure.  It is all about graft placement to achieve this shingling effect.  

A few years ago I visited with a group that used a semi robotic unit.  It would "suck" the graft into the unit, (almost like vacuuming), and simultaneously the unit would make the site and place that same graft in its place.  It was awesome to see.  The key to this particular system, it worked on a "wet" concept.  Thus, the graft would always be moist.  Consider how much air/power is required to get the graft and to then put it in place.  This could very well dry up the graft. This would result in a not very viable graft.

It will be interesting to see what is developed in the next few years.  In my view the human hand and the experience of the doctor count a great deal.  A robot can not "see" while the doctor can.  Cross sectioning is minimized, etc.  Making sites in the angle and direction of the native hair can better be done with the hand of the doctor.  More to come.

It will be interesting to read what others think about this.  Cool topic....

My question...who is doing the harvesting...a tech or the doctor? If it's a tech, and the unit does most of the work, the tech would be in charge that entire time.  I have an issue with this.  There has to be a difference between a tech and a doc, (years of education).  Don't you think this is an issue?

[Melvin- Admin]

Watch this video

 

[anker21]

Great video I wonder whether stick and place allows for closer dense packing vs pre-made slits. And what the advantages and disadvantages are for both methods.

[gillenator]

Probably the main benefit of "stick and place" is that the graft is placed immediately after the slit is created...there is less potential for deteriation of the graft tissue (ischemia reprofusion) although alternatively many docs place their grafts in a viable cold solution before placement....another benefit is reduced time for slit swelling thereby allowing for the recipient sites to be made closer together.  

Does "stick and place" improve the overall yield?....probably more studies are needed to determine it.

[Gasthoerer]

The first question: 

Are you talking about Stick&Place with slit and forceps or DHI with implanter pen?

If the first is what you are talking about, then the mentioned benefits are

+ Less out of body time of the grafts --> Better survival.

+ Smaller slits possible --> Higher theoretical density. 

No ones knows if this is really true though. 

- Takes much longer -->more taxing on the patient and the clinic team Only smaller cases possible.

- Much more difficult to select which graft have to go where, as you cannot pre-select them. 

- More difficult to create an complete area evenly (this is what a clinic told me)

 

 

[Melvin- Admin]

On 10/22/2020 at 1:40 PM, anker21 said:

Great video I wonder whether stick and place allows for closer dense packing vs pre-made slits. And what the advantages and disadvantages are for both methods.

The lateral slit technique pioneered by Hasson and Wong allows for some of the highest density ever produced. 

[Portugal25]

It`s true that Stick&Place is more demanding because the Doctor has to make the punch and immediatly implant the graft he does this one graft at a time therefore limiting the maximum amount of grafts per day to around 1000 for Doctors doing manual extraction up to 2000 for Doctors doing motorized extractation.

It`s because of the difficulty to select which graft has to go where (as you cannot pre-select them) and the bigger challenge to create a complete area evenly that I never reccomend chosing this technique with a Doctor that isn`t doing the whole surgery on just 1 patient per pay. 

Like @Gasthoererexplained:

+ Less out of body time of the grafts --> Better survival.

+ Smaller slits possible --> Higher theoretical density.

The best hairlines I have seen with this higher density @Gasthoererrefers to above was from Doctors doing stick&place (or DHI) like Konior, Nadimi, HLC, Pekiner and even Kesser that doesn`t use a microscope during surgery (he does also have some subpar hairlines with multis but that’s to be expected from a Doc not using a microscope). 

DHI is a similar technique but less taxing on the Doctor because the implantation isn`t done manualy with forceps but rather with a implantor pen charged with the graft that punches and implants the graft at the same time thus making this process much faster and simpler.

I do believe most of the Stick&Place Doctors will be evolving to DHI in the near future as it provides similar results and allows for more grafts to be implanted in 1 day with less physical strain on the Doctor.

In my humble opinion, Doctors doing more than 1 patient per day is only a option if the technique is FUT or FUE with pre-made sits supported by a great tech team (H&W, Feriduni, Muresanu, Bisanga, etc).

Ofcourse this is just my personal opinion.

Edited October 28, 2020 by Portugal25