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 Dr. True |
MRSA CONCERNS Infection is possible after any cutaneous surgery, and considering the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a community-acquired pathogen, this organism must be considered as the etiologic agent in any patient who presents with evidence of postoperative wound infection.
 Dr. Mangubat |
Treatment should be modified as needed, pending the culture and sensitivity results, taking into account local antibiotic resistance patterns. For MRSA infection that fails initial antibiotic treatment, linezolid (Zyvox, Pfizer) 600 mg q12 hours is the treatment of choice, although consultation with an infectious disease specialist is prudent in this situation, Dr. True says.
 A hair transplant donor incision infected with MRSA. (Photo credit: Robert True, M.D.) |
POSTOPERATIVE CARE The need for perioperative antibiotic prophylaxis to avoid infection after hair restoration surgery is somewhat controversial. There is no evidence to support its routine use. In the interest of practicing defensive medicine, however, E. Antonio Mangubat, M.D., says he gives all patients the option of receiving a five-day course of cephalexin, beginning with the first dose given prior to surgery.
"If the patient was not offered an antibiotic, gets an infection with a poor outcome and the case turns into a malpractice suit, the surgeon will likely be held at fault," says Dr. Mangubat, a board-certified cosmetic surgeon in Seattle.
GROWTH AND LOSS ISSUES Poor growth is a relatively common occurrence after follicular unit transplant surgery. Prevention is the best management for this complication, and that requires understanding of the multiple possible causes, Dr. True says.
Compromise of the vascular supply in the receptor area is a major factor, and this may be a particular issue for patients who are smokers or diabetic. Due to its vasoconstriction properties, epinephrine use in the tumescent anesthesia solution may also play a role.
"The effect of epinephrine on the vasculature has been shown to persist for one to two days after injection, and so surgeons might be especially careful about eliminating it from the tumescent anesthesia solution for patients who are already at risk for vascular issues," Dr. True says.
Graft trauma can also underlie poor growth, and that may be a consequence of poor dissection techniques, desiccation after extended time out of body, rough insertion or over-cutting, which may be done to increase the number of grafts obtained. Infection and inflammation of the receptor area are other factors that can lead to poor growth.
