Paul Shapiro MD
Valued member
4,644 FU case, Norwood Type 6, Dr. Paul Shapiro
This patient was a perfect candidate for a large megasession.
He is a 52 year old Norwood Type 6 with a very good donor. He is healthy without any history of high blood pressure, diabetes, smoking, etc.. In these large megassessions the patient is sitting still for a long period of time and we give large doses of lidocaine and epinephrine. So I want the patient to be healthy to avoid any possible medical side effects.
Our goal was to get as much coverage as possible. As you can see I packed more densely in the front ½ and still did not completely cover the crown. I would say I covered about 150 sq cm of scalp but I did not measure it.
When I do a large case like this I take ½ of the donor out in the morning and the other half of the donor out just before lunch. I have the technicians keep grafts from the first ½ of strip separate from the second half. I want the grafts from the earlier strip to get placed first. My goal is to have the FU s placed within 4 to 5 hours of being out of the body. Studies show that grafts survival decreases the longer the FU s are out of the body. Studies shows that at 4 hours out of the body the graft survival rate is 95% and at 6 hours the graft survival rate is 90%.
In this patient I finished harvesting the first half of the donor at 9:30 am. By noon our technicians had almost finished cutting this first half section. I then removed the second half of the donor and we broke for lunch. The technicians started to place the one hair FU s at 12:40 in the hairline and were done placing the hairline 1:40pm. I usually use 400 to 500 one hair FU s in the hairline. The whole session was finished at 7:30. I would have preferred to be done a bit earlier for the safety of the follicles, but I can say that the majority of the hair follicles were placed within 4 to 5 hours of being out of the body.
By the end of the session the patient was grumpy and complaining of back pain but happy that he had such a large session. He is a type A guy and even with valium on board, it was difficult for him to sit still for that long. The last two hours were especially difficult and we would have been finished earlier if he had not been so fidgety at the end of the day. I find a patients personality, and a history of back pain and/or neck pain are important to know when planning a long day of surgery.
Here is the breakdown of grafts and hair count.
1 Hair FU - 983 Hairs 983
2 Hair FU 2703 Hairs 5406
3 Hair FU - 856 Hairs 2568
4 Hair FU 102 Hairs - 408
Total FU - 4644 Total Hairs 9365
The total length of the strip was 26.5 cm long.
At its widest the strip was 2cm wide in the middle and at the temples the strip was 1.5cm wide. The strip dimensions was as follows
10.5 cm long of 2.0 cm wide strip
9.5 cm long of 1.8 cm wide strip
7.5 cm long of 1.5 cm wide strip
Taking a total FU count of 4,644 FU and a total area removed of 49.35cm his donor calculates to 94 FU/cm.sq which is higher then average. On average most donor strips have 80 FU/cm.sq.
This patient was a perfect candidate for a large megasession.
He is a 52 year old Norwood Type 6 with a very good donor. He is healthy without any history of high blood pressure, diabetes, smoking, etc.. In these large megassessions the patient is sitting still for a long period of time and we give large doses of lidocaine and epinephrine. So I want the patient to be healthy to avoid any possible medical side effects.
Our goal was to get as much coverage as possible. As you can see I packed more densely in the front ½ and still did not completely cover the crown. I would say I covered about 150 sq cm of scalp but I did not measure it.
When I do a large case like this I take ½ of the donor out in the morning and the other half of the donor out just before lunch. I have the technicians keep grafts from the first ½ of strip separate from the second half. I want the grafts from the earlier strip to get placed first. My goal is to have the FU s placed within 4 to 5 hours of being out of the body. Studies show that grafts survival decreases the longer the FU s are out of the body. Studies shows that at 4 hours out of the body the graft survival rate is 95% and at 6 hours the graft survival rate is 90%.
In this patient I finished harvesting the first half of the donor at 9:30 am. By noon our technicians had almost finished cutting this first half section. I then removed the second half of the donor and we broke for lunch. The technicians started to place the one hair FU s at 12:40 in the hairline and were done placing the hairline 1:40pm. I usually use 400 to 500 one hair FU s in the hairline. The whole session was finished at 7:30. I would have preferred to be done a bit earlier for the safety of the follicles, but I can say that the majority of the hair follicles were placed within 4 to 5 hours of being out of the body.
By the end of the session the patient was grumpy and complaining of back pain but happy that he had such a large session. He is a type A guy and even with valium on board, it was difficult for him to sit still for that long. The last two hours were especially difficult and we would have been finished earlier if he had not been so fidgety at the end of the day. I find a patients personality, and a history of back pain and/or neck pain are important to know when planning a long day of surgery.
Here is the breakdown of grafts and hair count.
1 Hair FU - 983 Hairs 983
2 Hair FU 2703 Hairs 5406
3 Hair FU - 856 Hairs 2568
4 Hair FU 102 Hairs - 408
Total FU - 4644 Total Hairs 9365
The total length of the strip was 26.5 cm long.
At its widest the strip was 2cm wide in the middle and at the temples the strip was 1.5cm wide. The strip dimensions was as follows
10.5 cm long of 2.0 cm wide strip
9.5 cm long of 1.8 cm wide strip
7.5 cm long of 1.5 cm wide strip
Taking a total FU count of 4,644 FU and a total area removed of 49.35cm his donor calculates to 94 FU/cm.sq which is higher then average. On average most donor strips have 80 FU/cm.sq.
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