Micro excisional graft removal

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There are 3 main instances in which a graft warrants removal: When they are misplaced, when increased hair loss exposes them further, or when grafts are pitted/ prominent. In this presentation, we explore the removal techniques as well as the most common risks associated with each. Particular attention will be given to the Micro-incisional technique, and advanced technique for graft removal that decreases the chance of re-growth of hairs in the original removal site while also limiting the incidence of scarring.

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Micro Excisional Graft Removal

Paul T. Rose , MD JDBernie Nusbaum, MD

Conflict of Interest

None

Need for Graft Removal

Misplaced grafts Increased hair loss exposing grafts Pitted grafts/prominent grafts

Techniques for removal of grafts

En bloc excision Punch removal

Hand held punch or mechanized device

Problems with Graft Removal

Transection- inability to account for hair angles

Burying of graft Inability to remove due to

tethering/scarring

Use of a Punch

Micro-incisional Technique

Use of custom made blades Blades can be cut to size attached to

various blade holders Depth can be set The incisions are directed AWAY from the

hairs Three to four incisions are made-these

may need to be joined, triangular or square/rectangular wound

Micro-incisional technique

Graft is lifted with forceps – at times two are needed

The blade can be inserted into the space created to cut any fibrous strands

Wound is allowed to heal via second intention healing

Micro Incisional Technique

Micro Incisional Technique

Advantage of Micro-incisional technique

Decreased rate of transection- more hairs for location to other sites

Less chance of re-growth of hairs in at original graft removal site

Small wounds-limited scarring, second intention helaing

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