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What is a Multi-Blade Scalpel?

multi-blade scalpel
An early tool in strip surgery was the multi-blade scalpel.

The multi-blade scalpel was used by most hair transplant surgeons during the early days of strip excision surgery. A multi-blade scalpel consists of a single handle with multiple blades, usually two-to-four blades in total. Clinics may still use this type of scalpel for strip removal, but most agree that there are better tools for donor strip removal.

 

How is a Multi-Blade Scalpel Used?

The multi-blade scalpel is still sometimes used for follicular unit strip surgery (FUSS) procedures:

  • For this type of procedure, the physician removes a strip of hair from the back of the head (donor zone). Multi-blade scalpels will typically leave a heavier scar than single blade scalpels.
  • Using a stereoscopic microscope the strips from the donor zone are dissected into individualized follicular units (follicular units contain all of the structures of the hair follicle as well as some accompanying tissue).

 

Multi-Blade Scalpel vs. The Single-Blade Scalpel

A multi-blade scalpel can be useful for speed, but absolutely disastrous for donor hair and the donor zone if not used properly. This is because multi-blade scalpels are less maneuverable, which can make it difficult to dissect the donor strip without causing high rates of transection. The use of multiple blades also increases the likelihood of making too deep of an incision, which increases the possibility of infection, necrosis, and unsightly results such as wide donor scars, permanent shock loss, and persistent or chronic numbness due to too many nerves being damaged.

The more blades a scalpel contains, the more likely the physician is to transect the follicular units (a transection means that the follicular unit has been damaged by making contact with the surgical instrument). In fact, one study found that up to 25% of hair follicles are damaged by multi-blade scalpels when incising the donor zone. During this study, even the best surgeons still lost up to 10% of the overall follicular harvest from the donor zone by using scalpels with multiple blades. Since the donor zone contains a limited amount hair, it is critical that the number of transected follicles be kept to a minimum. A single blade is more efficient for this reason and because:

  • It allows for better maneuverability in between follicular bundles. In fact, when a skilled hair transplant surgeon pushes, instead of pulls, a single blade scalpel along the donor zone to incise the superficial tissue a clear path (with proper magnification) can be easily seen effectively allowing the physician to keep transections to low single digit percentages.
  • More narrow donor scars are easily achieved due to the ability of single blade scalpels to change direction for narrowing the donor strip in areas of high tension. This cannot be done with multi-blade scalpels because if one blade is moved they are all moved thus keeping an equal distance between the top blade and the bottom blade throughout the donor strip.
  • A more consistently shallow incision thus reducing the incidence of permanent nerve and vessel damage. This in turn reduces the chances of infection and necrosis.

However, a major advantage of the multi-blade scalpels is that they cover a greater portion of the scalp in less time, which makes hair transplants exponentially quicker. This advantage is debatable since it this increase in speed comes at a very high cost to the donor zone.

 

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