The FUT strip procedure derives from the old technique of
strip harvesting, where a thin strip of skin is removed from the back of the
scalp or permanent donor zone to yield the donor hair. Formerly, the strip
procedure has been largely responsible for majorly unwanted results of hair
plugs and donor scarring and bruising. However, with the new advancement of
follicular grafting and micro dissection, things have changed for the strip
procedure. It is now favored by many surgeons for yielding the greater number
of even quality hair grafts in comparison to the FUE procedure; and achieve
full head coverage under a 7hour session.
The FUT procedure shares only the approach of using skin
dissection for yielding hair grafts, whereas, it differ in the following
measures.
·
Use of
local anaesthesia
Previously, the strip method was performed under general
anaesthesia which raised the issues of blood loss during surgery; bruising;
scarring. Often the scars would be bumpy. The use of local anaesthesia
constricts the blood vessels of the treatable area and stiffens it resisting
against excess blood loss. The incision of the donor strip can thus be fine and
so would be the scar.
·
Use of
single blade incision
The use of lateral slit incision with a single blade scalpel
has replaced the multi-bladed incision type. The single blade scalpel reduces
the chances of graft transection in way of the strip removal. The multi-bladed
incision was done with a specially designed instrument with a row of blades
like in a razor that was implemented to reduce scarring. The multiple bladed
incisions just didn’t work as expected that now the single blade incision has
succeeded to achieve.
·
Follicular
Grafting
As we know it, hair grows out of a single follicle, but the
hair placement in a scalp occurs in 2 to 5 hair follicles closely residing in
the scalp as a group or unit undetectable with naked eye; these are referred as
follicular units. It is extracting these follicular units with a little fatty
tissue enwrapped around them that makes a complete hair graft.
The follicular grafting process is abided by both FUT and FUE procedures. In FUT
the strip of skin is placed under a microscope and with a fine needle is the
follicular grafts dissected from the skin. Whereas, in FUE the hair of the
entire donor zone is close cropped and the follicular units are easily detected
with 30x magnification.
·
Undermining
Undermining is a technique that is performed occasionally
mainly to relive tension during closing and suturing the donor wound if the
candidate’s scalp is too tight, or there have been hair transplant surgeries
done previously. It is done by separating the skin layers around the wound
edges.
Usually surgeons avoid undermining, mainly because it has
the potential risks of injuring nerves, bleeding, slow healing and scarring.
But it is only made a part of the procedure of a predetermined and well planned
surgery.
·
Trichophytic
Closure
The trichophytic closure or “tricho” closure reduces the
chances of scarring with some systematic and coordinated incision and closure
patterns. The closure technique allows the existing hairs to grow through the
linear scar hiding it at the most. Usually the tricho closure requires the
donor area to be sutured than stapled.
·
Use of
Absorbable Sutures and Staples
The closure of the donor wound can either be with staples or
sutures. Both can reduce scarring. While staples are advantageous of being
inert this causes lesser inflammation and resulting in lesser risk of damaging
the existing hair at the back of the scalp after the donor harvesting. The
staples also reduce the chance of strangling hair follicles with its
interrupted clipping in contrast to an uninterrupted running stitch.
Absorbable sutures on the other hand abort the event of
cutting the suture and disturb the operated areas anymore. Absorbable sutures
allow the surgeon good precision of closing the donor wound manually.
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