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Robert M. Bernstein, MD, William R. Rassman, MD, and Nazia Rashid
Dermatologic Surgery 2001; 27(1): 5-11.
College of Physicians and Surgeons, Columbia University, New York, New York
Background
The most common type of donor closure in hair transplantation is with non-absorbable, running sutures, usually of nylon or polypropylene. This is accomplished with, or without, buried absorbable sutures. Another popular method of closure is with stainless steel staples. Each of these methods has benefits and limitations with respect to healing, comfort and convenience for the patient.
Objective
The purpose of this study is: 1) to describe the use of Poliglecaprone 25 (Monocryl), a synthetic, absorbable, monofilament suture in hair transplantation surgery 2) to detail the suturing techniques needed to maximize the benefit of this suture and, 3) to compare this material and suturing technique to a well-established form of closure, that of metal staples in a bilaterally controlled fashion.
Methods
Poliglecaprone 25 (Monocryl) is a synthetic, absorbable monofilament suture of low tissue reactivity. It was compared to closure with metal staples in a bilateral controlled study. One side of the donor area was closed with Poliglecaprone 25 sutures (4-0 Monocryl) using a running cutaneous stitch and the other side was closed with stainless steel staples (3M-Precise DS-25). Patients were evaluated with regard to healing, post-operative discomfort, resultant surgical scar, and closure material preference.
Results
Of the 22 patients studied, the following post-op complaints were noted on the staples side; tenderness (12), itching (4), swelling (2) and scabbing (1). This compared to only one complaint of itching and one complaint of swelling on the Monocryl side. Two patients had post-operative complaints of visibility of staples showing through their hair. Objective measurements revealed a wider scar overall on the staples side in six patients and wider scar on the suture side in 2 patients. The average scar width on the staples side measured 1.78mm compared to a 1.42mm on the sutures side. Fourteen of the 22 patients preferred Monocryl for future procedures; one preferred metal staples and 7 had no preference. Most patients stated that post-operative discomfort from the staples and the inconvenience and occasional pain associated with their removal was responsible for their decision.
Conclusion
Poliglecaprone 25 (Monocryl) is a strong synthetic, absorbable, monofilament suture with low tissue reactivity that can be used in hair transplantation to close the donor wound with a single, running cutaneous stitch. This suture can provide a donor closure that ensures hemostasis, has little risk of infection and is comfortable for the patient. If specific surgical techniques are followed, this suture can provide a donor closure that ensures hemostasis has little risk of complications, is both comfortable and convenient for the patient post-op, and results in a fine surgical scar.
