Saline and tissue holding solutions

[Julius]

I read somewhere that most hair transplant clinic use normal saline while some use tissue holding solutions which contain buffers, nutrients, and antioxidants which have been shown to reduce storage and ischemia-reperfusion injury. My question is do all coalition doctors use tissue holding solutions?

[Bill - Seemiller]

Julius,

 

The actual solution physicians use will vary. If you want to know specifically what each doctor uses and the benefits as they see it, you may want to send emails to some of our doctors to garner their input.

 

Best wishes,

 

Bill

[Julius]

Will do, thanks again.

[Balboa]

i have watched a few vids from a top UK doc and he says hes started using antioxidents etc as the reseach shows positve effects

[Julius]

After the donor strip is harvested, it and the grafts which are dissected from it are placed in what is called a "holding solution". This medium can be as simple as normal saline, or it can be made up of a number of ingredients whose purpose is to maintain the health of this living tissue.

SMG, Feller and H&W all use saline, with one saying they are confident holding solutions offer little benefit over saline.

However I remember another recommended surgeon on this forum saying that he uses a tissue holding solution which contained buffers, nutrients, and antioxidants which have been shown to reduce storage and ischemia-reperfusion injury.

This is rather convincing and surely it sounds better than just saline in stopping the follicles being damaged or dehydrated, thus increasing the survival of grafts.

Dr Cooley says “the bottom line is that for smaller cases and those lasting less than four to five hours, it may not matter”. In my opinion, using alternative holding solutions could give small but significant improvement in graft survival for cases lasting longer than five hours or greater than 2000 grafts.

“In our clinic, we place the strip and 'slivers' in HypoThermosol at 4-10 degrees celsius. IMO, this provides the greatest protection for grafts outside the body. For dissected grafts waiting to be placed, we put the grafts in cell culture solution (DMEM with HEPES buffer) for protection at room temperature. This solution has glucose, amino acids, buffers to protect the tissue”.

I would love doctors to say what they think is best saline or some other sort of tissue holding solution and if possible back it up with research. Other forum members please feel free to comment on what they think is better.

Why are the top docs not using tissue holding solutions when I have heard about so much positive research on them improving follicle survival?

Are they thinking of changing this in the future?

Cheers

Edited June 20, 2010 by Julius
Double negative

[Balboa]

SMG use Hypothermosol now i still dont know much on it but i was told by janna that they now use this rather than saline

[Dr. Michael Beehner]

Two years ago I did an extensive research study comparing grafts stored in normal saline for half of the 16 study boxes and grafts stored in hypothermosol solution with ATP added to it in the other half of the boxes. ATP is a chemical in our bodies that fights apoptosis (cell death) which occurs in the absence of oxygen. We planted grafts in the paired study boxes (one saline, and the other hypothermosol/ATP) at the following time points: 2 hours, 4 hours, 6 hours, 8 hours, 24 hours, 48 hours, 72 hours, and 96 hours.

The findings from this research is basically that for under 8 hours they are similar from a statistical standpoint. This confirmed the results Dr. Bobby Limmer in Texas achieved 19 years ago in his landmark study going out to 48 hours.In our study, for 24 hours and thereafter, there was a huge difference in survival in favor of the Hypothermosol/ATP grafts doing much, much better in survival percentage. Besides the superiority in percentage of grafts that survived, there was also a qualitative difference between the grafts in saline and those in hypothermosol at 24 hours and beyond, again with the hairs growing from the Hypothermosol/ATP boxes being much fuller in diameter, while the ones in saline were thinner. If anyone wants to know the exact percentages, I could dig them up and put them here.

In our own practice we use Plasmalyte solution to hold all of our grafts, which is very close in ph (acidity) to human plasma. Dr. Bill Parsley recommended it to me around 4-5years ago. It is certainly more expensive than saline, but not exorbitant. Hypothermosol (and especially if ATP was added) on the other hand is much, much more expensive and, if used routinely in HT, would have a serious impact on the price patients would have to pay to have the procedure done. The evidence so far certainly does not support the routine use of such an expensive solution. Perhaps there might be the occasional patient in whom a large number of pluggy grafts are being FUE's out of the scalp and recycled into the scalp. Such grafts may be more susceptible to cell death and benefit from this type of fancy solution. Dr. Jerry Cooley has also done recent research using Hyporthermosol with ATP added (in fact, he gave me the idea!), but I don't think we can even sort out from our research what percentage of the benefit was due to the Hypothermosol versus the contribution from the added ATP.

The instances in which grafts have to be placed days later are very rare. I have only had one such episode in 22 years, when around 10 years ago a 35 year old developed chest pain and sweating during the procedure right after we had harvested all of the donor hair and had made around 200 small recipient sites, and we had him moved immediately by ambulance to the hospital, where he was cleared that night at 10PM and sent out with a diagnosis of a virus and some hyperventilation. He called me that night and we agreed to meet the next day, at which time we inserted the grafts and finished the procedure. These grafts were out 24 hours and grew fairly well from visual observation. In all truth, it's pretty much impossible to distinguish 70% growth from 95% growth, which has been proven by Dr. Manny Marritt years ago and published in Derm Surg Journal.

So the bottom line is that the jury is still out somewhat on what the perfect solution is. We've been using Plasmalyte for around 4 years now for the theoretical reasons I noted above, and I can't say that I have noted any difference grossly from the growth we received all those years using saline.

Mike Beehner, M.D.

[Balboa]

very interesting post thanks for taking the time to post that.

[Julius]

Thank you Dr Beehner

[RCWest]

Some HT doctors use Lactated Ringers Solution. That's what doctors use to irrigate open wounds.

[Tonycc]

Good info, Dr. Beehner. Thanks for sharing