Objectives: Objectives:
As FUE is getting popular with every passing day, more and more types of punches are coming in the market. It is difficult for the doctors to choose between them. Most of the punches are promoted by the doctors who have a conflict of interest with one kind of punch. So as an unbiased and having no conflict of interest we thought lets determine the difference between the grafts yields using three different types of punches namely, sharp, serrated and blunt. There are other punches as well but we did not use them for this study.
Introduction: This was a prospective, randomized, study. Only the patients undergoing 1st session of strip harvest were included. The donor area was marked in sitting position. Three rows of 5 boxes were made on the occipital aspect of scalp with in safe donor area.
The row of selection for the type of punch was selected randomly, so that the area bias can be removed. Each horizontal row of 5 boxes were then harvested by same surgeon using one type of punch. The surgeon was familiar with all three different types of punches and had no personal preferences of the surgeon.
Materials / method: 3.5 magnification loupes were used to harvest each box. Although only three types of punches were used, but the surgeon was aware of other types of punches, namely funnel, flat punch etc.
these grafts harvested were then looked for transactions of hairs rather the transactions of grafts.
We only calculated the hair transactions as oppose to grafts transactions. Whether the graft had a total or partial transaction was not calculated but all hairs were counted and then the roots were seen for transactions. A partial transaction of 1 out of three hair graft was considered as one hair transaction
Results: In all 5 areas of harvest blunt punch had the maximum yield of hair per follicular unit. On an average blunt punch had the least transactions in total. The sharp punch had the maximum number of transactions and least yield of hair per follicular unit.
This clearly shows that a blunt punch is more forgiving in nature. The difference between the blunt and serrated was not significant. The central part of the scalp usually used for studies had less graft transactions as compare to the sides. This is usually due to the acute angle of exit from the skin and change in the skin character
Conclusion: So most studies showing the transactions are not true reflection of transaction rate, due to the non inclusion of these extreme areas. We did not calculate the fatigue factor on transaction rate when doing more than 2000 grafts surgery. This is an area which we will do a study by next year and publish our data.
in general, the punches with sharp edges on outer side, or a blunt punch, or a flat punch with outer rim as sharp are safer.
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