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Figure 4. (Left) A 28-year-old man with burn alopecia who sustained severe third-degree burns of the upper body, neck, face, and scalp. (Right) One year after a second session for a total of 2500 micrografts and minigrafts. |
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Figure 5. (Left) A 32-year-old man with a history of severe third-degree burns from an explosion at work shown after multiple reconstructive procedures, including a deltopectoral flap to resurface his lower face. (Right) A year after 2 sessions, for a total of 1100 grafts (harvested from the occipital area). Notice the degree of camouflage of the flap and residual scars; a second procedure is planned to increase density. |
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Technique
Usually, these procedures are performed with the patient under intravenous sedation and local anesthesia, unless the patient is a child, in which case the procedure is performed under general anesthesia. Midazolam (Bedford Laboratories, Bedford, Ohio), usually 2 to 10 mg, and fentanyl (Abbott Laboratories, North Chicago, Ill.), usually 50 ug, are used for the sedation; 0.5% bupivacaine (Abbott Laboratories) with epinephrine 1:200,000 is used for nerve blocks and local infiltration. The technique for scalp hair transplantation is basically the same as the one described previously as slit and immediate insertion of the grafts.8-11 With the patient in the supine position and mildly sedated, occipital nerve blocks and supraobital nerve blocks are created with 0.5% bupivacaine with epinephrine 1:200,000; the donor site is harvested from the occipital area as a horizontal ellipse (Fig. 10, above, right). Subsequently, a mild tumescent infusion is given using 0.25% lidocaine (Xylocaine; AstraZeneca LP, Wilmington, Del.) with epinephrine 1:200,000 (approximately 30 cc) for hemostasis, in order to intentionally produce temporary edema, which facilitates graft insertion.
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