Clinical Application of Single Hair Graft Using Choi Hair Transplanter

The transplantation of a large number of hair graft has become an important method in hair restoration surgery and reconstruction of pubic hair and eyebrows. Between September 1996 and December 1998, single hair graft using Choi hair transplanter was performed for 22 patients with male pattern baldness, 8 patients with alopecia of pubis, 6 patients with alopecia of eyebrows ranging from 20 to 59 years of age. Usually between 1000 and 1500 single hair grafts per session are performed on male pattern baldness, between 350 and 500 grafts on alopecia of pubis, between 150 and 250 grafts on alopecia of eyebrows. All procedures were done under intravenous sedation and local anesthesia. A donor horizontal ellipse of scalp is harvested from the occipital area. Questionaires regarding cosmetic satisfaction, side effects and general efficacy of hair transplantation were recorded by patients themselves one year after surgery. The procedure has been proved to be safe and patients can expect aesthetically satisfactory results. No serious complications were reported The complications including facial edema, temporary sensory change on the donor site, and folliculitis were observed and resolved spontaneously. The use of single hair graft using Choi hair transplanter for the correction of male pattern baldness, alopecia of pubis and alopecia of eyebrows has been proven as one of the safe and effective method in obtaining excellent results.

Clinical experience of ear elevation after reconstruction of microtia

The basic technique for total reconstruction of the microtia was established by Tanzer, who utilized autologous rib cartilages for constructing the auricular framework. In order to decrease the number of surgical stages and to achieve maximal convolution, we employed a surgical procedure with simultaneous three layered costal cartilage grafting for the high profiled auricle, concha formation and lobule rotation. However, we performed ear elevation as an additional procedure for some patients who had decreased helical height due to absorption of cartilage framework or postoperative trauma and who had wanted to wear the spectacles or to have more natural appearance of auriculocephalic sulcus. From August 1988 to October 1997 we had performed surgeries for the ear elevation of 58 patients in 177 patients with total ear reconstruction, using various elevation methods; skin graft, local flap, and local with costal cartilage block. When the ear elevation was performed with skin graft, postoperative contraction of the grafted skin was inevitable. In cases with two skin flaps, it was difficult to stabilize and maintain the correct projection of the constructed ear. So we elevated the reconstructed ear by utilizing a costal cartilage block, two skin flaps to cover the posterior region and skin graft. We conclude that the local flap with costal cartilage block is one of the most favorable methods in ear elevation which can maintain the adequate projection and make natural looking auriculocephalic sulcus.

New method of tie-over dressing

The most important basic requirements for successful skin grafting are the accurate approximation of the edge of the skin graft to that of the wound and the application of even pressure to the graft by a carefully designed dressing. Pressure dressing is indicated for the protection of the graft and the prevention of shearing between the graft and its bed. One of the most widely used methods of pressure dressing is tie-over dressing. The traditional technique is based on the application of long silk sutures along the margin of the graft that are tied over bolus of antibiotics oint-impregnated nonadherent fluffed gauze. With the traditional tie-over dressing, it is impossible to inspect the graft bed for possible hematoma and seroma during the application of dressing. So we adopted another modification of the previously described tie-over dressing methods. From January 1997 to July 1997, we had performed 27 skin graft surgeries and 8 subdermal shavings in 35 patients with our new method of tie-over dressing. We can apply even pressure to the grafts by twisting the long silk sutures instead of typing.In comparison with the plethora of devices and techniques described previously in tie-over dressing construction, our technique offers simplicity and reliable fixation of the graft to the bed and allows further adjustment of the dressing by individual tightening of the threads. Other particularly attractive features are the ability to inspect the graft at any time with little difficulty and the reapplicability of tie-over dressing with the remaining long threads if needed.