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Fue surgical assistant's role

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Describes how the role of the surgical assistant changes for follicular unit extraction surgery

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Fue surgical assistant's role

  1. 1. FUE: The Surgical Assistant’s Role Tina Lardner Denver, Colorado ISHRS 19 th Annual Scientific Meeting Anchorage, Alaska September 14-18, 2011
  2. 2. Disclosure <ul><li>I have no relevant financial relationships </li></ul><ul><li>to disclose in regards to this activity. </li></ul>
  3. 3. Objective <ul><li>Assistants still play an essential role in FUE </li></ul><ul><li>Grafts more delicate, thus their proper handling is important for the overall success </li></ul>
  4. 4. Assistant’s Role <ul><ul><li>Patient prep </li></ul></ul><ul><ul><li>Assisting in surgery </li></ul></ul><ul><ul><li>Graft extraction and inspection </li></ul></ul><ul><ul><li>Graft placement </li></ul></ul><ul><ul><li>Post-op care </li></ul></ul>
  5. 5. Overview of FUE
  6. 6. 1. Patient Prep <ul><li>Total shave </li></ul><ul><ul><li>Exposes all the follicles </li></ul></ul><ul><ul><li>More efficient </li></ul></ul><ul><li>Microstrip shave </li></ul><ul><ul><li>More discrete </li></ul></ul><ul><ul><li>Hair must be at least an inch long to hide extraction sites </li></ul></ul>
  7. 7. 2. Assisting in Surgery Superior to the patient Opposite to the physician’s hand Prone, exposing occiput area Side, exposing temporal Area Surgeon Position Patient’s Position Assistant’s Position Patient’s Position
  8. 8. 3. Graft Extraction <ul><li>Assistant’s responsibility </li></ul><ul><ul><li>Harvest grafts </li></ul></ul><ul><ul><li>Monitor graft transections and capping </li></ul></ul><ul><ul><li>Maintain hemostasis </li></ul></ul>
  9. 9. 3. Graft Extraction <ul><li>Single pull Pull – Push Hand over hand </li></ul><ul><li>Do not allow serrations on forceps to interlock… </li></ul><ul><li>RISK OF CRUSH INJURY! </li></ul>
  10. 10. 3. Graft Extraction - Capping <ul><li>Epidermis slides off during extraction leaving follicles behind </li></ul><ul><ul><li>Reasons: scar tissue or mushy dermis </li></ul></ul>Upper third of epidermis is removed Cap
  11. 11. 3. Graft Extraction Challenge
  12. 12. 3. Graft Extraction <ul><li>Efficient </li></ul><ul><li>Progressive extraction, stay out of the physician’s way </li></ul>Second pass Third pass 1st pass 2nd pass 3rd pass 1-2cm wide <ul><li>Feedback </li></ul><ul><li>Count extracted grafts, total their number, give feedback to the physician </li></ul>
  13. 13. 3. Graft Extraction <ul><li>Efficient </li></ul><ul><li>Progressive extraction, start at the upper occiput then move right to left, finish one strip, start new strip inferiorly until area is extracted, and remove tape </li></ul><ul><li>Feedback </li></ul><ul><li>Count extracted grafts, total their number, give feedback to the physicians </li></ul>
  14. 14. 4. Graft Inspection <ul><li>Requires 1-3 assistants </li></ul><ul><li>Inspection for </li></ul><ul><ul><li>Graft quality </li></ul></ul><ul><ul><li>Hair counts </li></ul></ul><ul><ul><li>Total graft count </li></ul></ul>
  15. 15. 4. Graft Inspection
  16. 16. 4. Graft Inspection Sebaceous glands Terminal follicles: pigmented with bulbs extending to fatty layer Epidermis Dermis Fatty layer Bulbs Epidermal cap Miniaturized follicle
  17. 17. 4. Graft Inspection Transection Examples of telogen follicles
  18. 18. 4. Graft Inspection <ul><li>H-factors </li></ul><ul><li>Caps </li></ul><ul><li>3 Types of transections </li></ul>Stripped dermal sheath Damaged bulb Damaged hair shaft Transection Epidermal Cap
  19. 19. 4. Graft Inspection FUE COUNT SHEET ( SAMPLE ) PATIENT:_____________________ DATE:______________ EMPLOYEE: SC AA AM HS AN BT CB Intact / transected <ul><li>Total # of </li></ul><ul><li>Intact follicles </li></ul><ul><li>Transected follicles </li></ul><ul><li>Caps </li></ul><ul><li>Density (hair/unit) </li></ul>14 2/0 7 4/1 13 1/0 6 CAP/ 12 3/0 5 3/2 11 4/2 4 4/0 10 3/0 3 2/1 9 4/1 2 3/0 8 2/0 1 2/0
  20. 20. 5. Graft Placement
  21. 21. 5. Graft Placement <ul><li>Delicate </li></ul><ul><ul><li>Dessication </li></ul></ul><ul><ul><li>Crush Injury </li></ul></ul>Hanging bulbs: no surrounding fat
  22. 22. 5. Graft Placement <ul><li>Because there is a lack of tissue, bulbs appear splayed </li></ul>Gently collect and grasp all the bulbs
  23. 23. 5. Graft Placement <ul><li>Uneven bulbs in addition to a lack of tissue </li></ul>Insert the longer bulb first , then guide the other bulb(s) in Note curvature of implanted hair follicle
  24. 24. 5. Graft Placement Incorrect placement Epidermis is not flush with the skin and hair is pointing in the wrong direction Epidermis flush with the skin Correct placement Epidermis flush with the surface of the skin
  25. 25. 5. Graft Placement <ul><li>Alternative graft placement methods </li></ul><ul><ul><li>Lion implanters: Dr. Jose Lorenzo (Spain) </li></ul></ul>
  26. 26. 6. Post Op Care <ul><li>Bandaging </li></ul><ul><li>Total shave Microstrip shave </li></ul><ul><li>Minimal discomfort </li></ul>
  27. 27. 6. Post Op Care 1 Day Post-op: Scabs have formed 8 Days Post-op: Hairs in between extraction sites have grown out FUE Scars: Although scars are difficult to see, if hair is cut too short, they become visible
  28. 28. Conclusion <ul><li>The role of the surgical assistant in FUE </li></ul><ul><ul><li>Different, not eliminated, still significant </li></ul></ul><ul><li>The importance of how we handle grafts during extraction, inspection, and placement are critical to successful growth. </li></ul>
  29. 29. Thank you