Question about Saline Spray Post-Surgery?

[Dr. Mike]

I sprayed my hair line post op repeatedly (about 10-20 mins sometimes) as well and I barely had any crust/scabs.

 

The constant spraying keeps debris and blood from building up.

[HairHope]

The saline spray I used worked like a charm, I was in great shape within 5 days. My first HT I used Grafcyte and my scalp was red for a month.

 

go figure.

[Dr. William Lindsey]

Interesting comments by patients and excellent docs alike.

 

I'll throw in a couple of thoughts too.

 

1. Moist wounds heal faster than dry wounds. Numerous studies in resurfacaing literature (chemical peels and laser), as well as my experience in peeling patients for 14 years now (including my mother) shows that healing occurs faster with moist wound surfaces. On the face, its easy...we use vaseline. Its cheap and it always works.

That being stated: on the hair, I have had equal numbers of complainers with dry scalp care or moist care (saline, free samples of products I got at meetings). And with the moist approach I get alot of men complaining that they look too greasy. You can't please everyone. So we currently do dry, with showering; but I am open to sprays as long as the patient isn't spending a bunch of money for stuff that has not been shown to be helpful in PEER REVIEWED AMERICAN medical literature.

 

2. Its dog gone hard to infect the scalp. Period. The great blood supply helps hair growth, and is constantly providing antibodies and all the nourishment to prevent infection. And, we use 5 days of a broad spectrum antibiotic too. In 13 years, I can only recall 2 scalp infections in hair, both in heavy smokers who didn't stop as I asked. And their scarline turned out about as good as anyone else's.

 

3. I am a huge fan of saline. Particularly ocean water. I have blogged on a bunch of our patients who took off to the beach after their transplant. Assuming they use sun-avoidance, they always look at least as good as patients who did everything "by the book" likely because that ocean water (after day 3) washed off the crustiness.

 

4. Redness happens and is normal. It looks worse and lasts longer in younger patients with redish complections, but it goes away. I wouldn't spend any money on trying to fix it.

 

In summary, there are lots of ways to recover from a hair procedure. Do what your doctor is comfortable with and that has worked for him/her. And don't spend a fortune on topical applicants that haven't been shown in peer reviewed literature to work.

 

Dr. Lindsey McLean VA

[Old Baldy]

Dr. Lindsey: How long do you recommend a patient use saline sprays or other moisturizers after surgery?

 

Is there any time limit, or can we use it for as long as we get relief (i.e., for me, I used homemade saline spray for about 3-4 weeks to also help with the intense itching I had)?

 

I used the saline spray less each day as time went on but it always gave me temporary relief from the itching.

 

Thanks for any info.

[Howzer28]

I've had three transplants. The first go-around was with a different doctor, I didn't use a spray and my head crusted (it was kind of gross with blood and other gunk), which made it more difficult transitioning back to work (the whole trying not to let anyone notice deal). My perception was also a longer healing process, itchiness, redness ??“ I looked like I had a disease and being 25, that isn't a good thing.

 

My last two transplants have been with Dr. Gabel, whom recommends spraying the transplanted area. Now I didn't follow his directions as prescribed, I cut down on spraying the transplanted area as the crusting subsided ??“ but of course that's the purpose, so I felt it was OK. Anyhow, I personally feel my head is more aesthetically pleasing and crusting has substantially subsided. I'm 10 days post op from my 3rd transplant and it's looking pretty darn good. Sutures are out. Now's the hard part is waiting for the things to grow!

[Dr. William Lindsey]

Old Baldy,

 

Do whatever your doc suggested. Today, we don't have patients spray themselves postop. I don't mind if they do, but CURRENTLY we don't tell folks to do it. Rather, I would prefer that after day 3 they shower and let shower water run over the area, and after day 4, that they GENTLY rub the recipient area in the shower, and they can shower twice a day if they like.

 

Anytime I start telling people to do specific things like spraying, or massaging their scars (which I am pretty emphatic about), I get some folks forgetting to do it, some doing it right, and some spending half their life doing it. Thus, right now, we are not pushing sprays, but if a couple of really crusty heads show up, or if I start thinking that it is altering ultimate outcomes, I'll change my mind.

 

Depending on a person's physiology and general health, their skin combined with moisture could allow growth of a variety of good and bad bacteria. If I were picking, I would have folks add just a bit of white vinegar to the saline, as that has a long track record of limiting bacterial growth and not hurting healing. In fact it is what I have ALL face chemical peel patients put on their faces until healed.

 

The downside, you smell like a tossed salad...

 

Dr. Lindsey McLean VA

[Steven Gabel, MD, FACS]

The day after surgery, patients will have some residual blood and dried serous fluid that has accumulated on their scalp. I have my patients return the following day after surgery to have their scalp cleaned of these. It is well documented in the facial plastic literature that keeping wounds clean helps prevent infection and generally patients heal better. I have them do this for several days until all the dried serous fluid has been washed away and they are not accumulating more on their scalp. There is no magic formula for the number of days as it varies from one patient to the next - as I have stated, I instruct my patients to "keep it clean and don't touch" and they grow out great. I saw a patient back yesterday for his sutures to be removed and he followed the regimen as best he could and his scalp looked great, very little redness, and almost 100% of the crusts had been washed away.

 

I have never suggested acetic adic (vinegar) to be added to the saline/water spray as I have not had experience with that for hair restoration. Yes, for facial chemical peels, we had all patients on day 1 through day 7 (or if needed) wash their face with vinegar/water solution as it has antimicrobial properties. Also, it is a common agent to use for patients who have outer ear infections to put them on Domboro, which is basically vinegar and water. Putting it on a freshly transplanted area - I'm not sure how the grafts would react and the saline rinses have been doing a great job.

[Dr. William Lindsey]

Dr. Gabel,

 

I too don't know how grafts would react to acetic acid/vinegar, so I don't recommend it either; it was a mental question to consider.

 

Since a.a. doesn't hurt skin graft take, it "ought" to be ok, but for now I am sticking with dry, and you are sticking with saline.

 

Lots of ways to proceed. Thanks for the comment.

 

Dr. Lindsey McLean VA

[Steven Gabel, MD, FACS]

Absolutely - but it is good to try to think of new ways of doing things to see if our techniques can be improved. Good discussion!!

[Old Baldy]

Originally posted by dr. lindsey:

Old Baldy,

 

Do whatever your doc suggested. Today, we don't have patients spray themselves postop. I don't mind if they do, but CURRENTLY we don't tell folks to do it. Rather, I would prefer that after day 3 they shower and let shower water run over the area, and after day 4, that they GENTLY rub the recipient area in the shower, and they can shower twice a day if they like.

 

Anytime I start telling people to do specific things like spraying, or massaging their scars (which I am pretty emphatic about), I get some folks forgetting to do it, some doing it right, and some spending half their life doing it. Thus, right now, we are not pushing sprays, but if a couple of really crusty heads show up, or if I start thinking that it is altering ultimate outcomes, I'll change my mind.

 

Depending on a person's physiology and general health, their skin combined with moisture could allow growth of a variety of good and bad bacteria. If I were picking, I would have folks add just a bit of white vinegar to the saline, as that has a long track record of limiting bacterial growth and not hurting healing. In fact it is what I have ALL face chemical peel patients put on their faces until healed.

 

The downside, you smell like a tossed salad...

 

Dr. Lindsey McLean VA

 

Ok, thanks for the info. Dr. Lindsey!

 

Thank you also Dr. Gabel!

[Janna]

Maxxy, I have a feeling he didn't misunderstand as I know other doctors recommending the same instructions. I will say after seeing some of their patients post operatively, I will state that their recipient site looked very good and clean without much scabbing.

 

We at SMG recommend our patients to use the solution of saline and graftcyte spray for the recipient site surface - not for regrowth. We used to ask our patients to spray with the normal saline spray until we were introduced to Graftcyte approximately 10 years ago. We switched to a mixture of saline/graftcyte solution because the concentrated spray just seemed to be too much so we compromised by diluting it with saline. We've seen the redness from surgery go away sooner with the mixture. The body is a wonderful thing and it will heal on it's own but many of our patients are professionals looking to return to work as soon as possible without hint of ht work so if the spraying the solution helps even a little bit with redness and healing, it's worthwhile to our patients.

 

We have pretty much the same protocol as Dr. Gabel and the reasons also being the same as he stated above in regards to spraying post operatively.

[HairHope]

Good discussion,

 

However, since I have repeated measures data on myself with two different treatments (with some washout - excuse the pun). The inter-individual variablity on healing is controlled for in my own situation. Although anectdotal, saline spray only as a post-op treatment worked significantly better (clinically) then Graftcyte in terms of healing.

 

Again, this is a within patient assessment - but on a VAS scale I would give it a 9 vs. 4.

[KO]

Looks like in the old days we had doctors actively discussing techniques. I found this helpful so bumping.

[aWidowsPeek]

Yep now the good old days when doctors would actually speak up lol. I can't blame most of them for avoiding these forums though with all of the dumb questions over and over as well as the angry posters with agendas.