Post-op question to IAHRS surgeon and unsatisfactory reply

[AGL]

Hi All,

This has been bothering me for a while as I just haven't been able to get a satisfactory response so I seek advice and answers from the community.

I had a FUT surgery 3 wks ago with a very recognized IAHRS surgeon. This was my second HT (first with this doctor) and the plan was for 4000 grafts, excising the previous scar. The finally tally per the clinic was 3501 grafts (average of 2 hairs per graft) and a strip size of 24.52 cm sq. Working the numbers 142.7 grafts/cm sq.

Based on what I see, read, hear and know about myself this is virtually impossible, especially as an average figure from the entire strip.

Although I've been told my donor density is above average the donor density varies from above ears, sides and back of head areas. The above ear region tends to have lower density than the other areas and although I do have above average donor density it cannot be approximately 143 grafts per cm sq throughout the entire strip. From my understanding 80 grafts per cm sq (above ears -least dense area) to 120 grafts per cm sq (back of scalp - most dense area) are considered above average which makes mine abnormally high and my density is not that abnormally high as I had it examined when I was consulting during my first HT. Something does not make sense to me; either the graft count or the strip size is incorrect.

I've contacted the clinic and some of the answers I received are BS, did not address the issue and are as follows:

-"Where you can get the 142.8 cm2 from?"

-"That is a very high density in your donor area so that is great news, that
just gives you that much more to work with over the long haul"

-"the density was very good in the donor area but 142.8 grafts/cm2 is not a density you can have in the recipient area because that area was larger than 24.52 cm2"

-"density changes from patient to patient. In your case you had a high density even though there is a scar from a previous surgery. You are very lucky that you had such a good density there. You can’t compare yourself to other people because everyone is different"

None of this answers my question and I'm concerned they have not been honest or have made a mistake of the count or strip size and without a good answer I feel cheated.

I do have to say that during the procedure the doctor and team seemed very nice, genuine and compassionate people and made me feel well taken care of and comfortable for the day.

Any comments or explanations would be much appreciated.

Thanks

[Tracy C]

Originally Posted by AGL

None of this answers my question and I'm concerned they have not been honest or have made a mistake...

I have read your post a few times now and assuming everything you have stated is truthful and correct, I just do not see any dishonesty in their answer. It seems to me that they did answer your question. I will come back and read it again after a while to see if anything jumps out as a red flag.

[AGL]

Thanks for reading my post. My issues is that 143 grafts/cm sq is very, very high. When an above average number is 100 grafts/cm sq. If you come across other posts where the patient documents the strip size and number of grafts, do a quick calculation to determine the number of grafts per cm sq in the donor region. Thanks again for reading and providing feedback Tracy.

[win200]

I don't see any dishonesty, but you're right, it doesn't seem that they answered your question. You asked them to comment specifically on whether a density of ~150 grafts per cm sq. was possible. I would draft a brief, concise email asking the following:

1. Can you confirm that the final number of grafts totaled 3,501, and that the area of the strip removed was 24.52 cm sq.?

2. Can you confirm that in order for a strip of that size to yield that number of grafts, the original density must have been 142.7 grafts per cm. sq.? (# of total grafts / sq. cm. of strip removed = density)

3. Can you comment as to whether you have, in your practice, observed a density of over 140 grafts per sq. cm. from a donor area? If so, how unusual is that density?

The shorter and clearer you make your email, the better--reduces the possibility for them to avoid the central question (this is my lawyer training speaking). Use numbered questions or bullet points. You need them to acknowledge that you had a donor density of > 140 sq. cm., and then to comment on whether that is possible.