Metal Combs Used for Hair Separation in Scalp Surgery

Abstract

Many head and neck surgery procedures are performed in the scalp area. However, during these procedures, hair usually interferes with the visualization of the surgical area, reducing the surgeons’ comfort. Other technical difficulties originating from hair include suturing and hemostasis problems, infection, and bad scar formation. Removal of the hair in the incisional area seems to be a promising method, yet it remains an inefficient solution, especially for patients with long hair. Removal of hair from a wide area around the planned incision also is not desired because it usually takes a long time for that scalp area to be covered with hair again, and most of these patients remain worried or annoyed until that time. To provide better exposure of the incisional area, certain methods are described in the literature, including petrolatum or ointment usage to keep hair flat [1], grouping of hair with rubber materials [2], and use of hair clips [3]. However, none of these applications has reached sufficiently wide acceptance to be implemented as a standard method. A new and simple technique for hair separation to increase surgical comfort has been designed. With this method, two or three pieces of medium-sized metal hair combs are used (Fig. 1). The combs are reusable after sterilization in an autoclave. The number and the size of the hair combs can be arranged according to the dimension of the surgical field and the needs of the surgeon. Thus, the hair surrounding the incisional area can be grouped in two to four opposite directions and held in place with the help of the hair combs (Fig. 2). The teeth of the combs secure the hair in place, and the combs can be left in position by themselves, diminishing the need for assistance. Nevertheless, an assistant also can hold the combs and apply gentle pressure on them for even better exposure. Hair constitutes a major obstacle in scalp surgery. It blocks visualization of the surgical field; makes it difficult to locate the suture thread, complicating the suturing process; and gets into the suture line, increasing infection risk, all of which contribute to an increase in the overall duration of the intervention. The hair gel or ointment used to keep hair flat must be carefully removed at the end of the procedure. Otherwise, it gives discomfort to the patient and blocks hair follicles, which can cause infection or hair loss. Application and removal of hair gel are time-consuming procedures, and the assistance they can offer during surgery is limited. Rubber bands and hair clips also are cheap and useful tools for hair partition, but their use is time consuming as well, and although grouped together, hair can still get between the surgical instruments and the surgical field. The aforementioned tools also are subject to frequent loosening during the procedure. Yet another drawback is the small but annoying pain they can provoke when they are removed from the hair postoperatively. The metal hair combs described in this report are designed to overcome these problems. They offer a practical approach that can effectively simplify and accelerate the procedure, enable the surgeon to work alone without any need for assistance, and improve the postoperative comfort of the patient. B. Ersoy (&) H. Şirinoglu Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Tophanelioglu Cad. No:13-15, Altunizade, 81190 Istanbul, Turkey e-mail: bubu77@gmail.com