Ergonomics in Hair Restoration Surgery: FUE Technique

61 Ergonomics in Hair Restoration Surgery: FUE Technique

Jean Devroye and Maria Angélica Muricy Sanseverino

Summary

Hair restoration surgeries are usually long and laborious affairs. Procedures typically exceed 5 hours of uninterrupted work and can reach more than 8 hours depending on the technique that is used. This requires both a lot of concentration and physical effort. Musculoskeletal disorders can be a medical problem for doctors and assistants. In the follicular unit transplantation (FUT) technique (single-strip excision), the most commonly performed procedure to the present time, advances in ergonomic design have been aimed primarily at technicians who spend most of the surgery performing repetitive movements. With the emergence of the FUE technique, the concern with ergonomics turned to the surgeon and the patient who must remain in place for between 1 and 5 hours, depending on the area to be transplanted, while the follicular units are excised from the donor area one by one. In the longest sessions, excision of a single follicular unit might be repeated more than 2,000 times or more. We believe that in order to achieve a good-quality FUE hair transplant, pain, fatigue, and discomfort must be minimized for both patient and surgeon.

Keywords: ergonomics musculoskeletal disorders FUE zero concept static position

Key Points

•Hair restoration surgeries are usually long and laborious affairs.

•Ergonomics is important for both the patient and the practitioner.

•It is important to analyze the whole aspect of the follicular unit excision (FUE) process to avoid musculoskeletal disorders.

61.1 Introduction

What is ergonomics? The site www.businessdictionary.com defines ergonomics as:

The study of capabilities and limitations of mental and physical work in different settings. Ergonomics applies anatomical, physiological, and psychological knowledge (called human factors) to work and work environments in order to reduce or eliminate factors that cause pain or discomfort. Ergonomic designs of tools and equipment have helped curtail the occurrence of musculoskeletal disorders and repetitive strain injuries.

Modern hair restoration surgeries are usually very long and involve repetitive movements. Procedures typically exceed 5 hours of uninterrupted work and can reach more than 8 hours depending on the technique that is used. This requires both a lot of concentration and physical effort. Musculoskeletal disorders (MSD) can be a medical problem for doctors and assistants.¹ In the follicular unit transplantation (FUT) technique (single-strip excision), the most commonly performed procedure to the present time, advances in ergonomic design have been aimed primarily at technicians who spend most of the surgery performing repetitive movements.

The two most common repetitive tasks are cutting grafts under a microscope and placing the grafts, both of can involve 2 to 4 hours in the same position (Fig. 61.1).

Fig. 61.1 Assistants working at surgical microscopes.

With the emergence of the follicular unit excision (FUE) technique, the concern with ergonomics turned to the surgeon and the patient, who must remain in place for between 1 and 5 hours, depending on the amount to be transplanted, while the follicular units are excised from the donor area one by one. We believe that in order to achieve a good-quality FUE hair transplant, pain, fatigue, and discomfort must be minimized for both patient and surgeon.

Williams et al² conducted a survey about MSD. Fifty percent of the 38 hair restoration surgeons reported musculoskeletal problems, but only 30% of them used ergonomic adjustments and tools when performing an FUE procedure.

The following important points related to ergonomics in FUE will be considered in this section:

•The main principles governing the ergonomics of the FUE technique.

•Position of the patient and the practitioner during follicular excision.

•Position of the patient and the practitioner during follicular placement.

•The choice of operating table or the chair for the patient.

•The choice of the surgical chair or stool for the practitioner.

•Recommended optical systems.

•Lighting of the surgical field.

•The ambient temperature.

•Stretching and massage of patient and practitioner.

•Workflow and positioning of assistants and surgeon around the patient.

61.2 Main Principles Governing Ergonomics of the FUE Technique

According to the theory of proprioceptive derived posture developed by Dr. Daryl R. Beach, a dentist and pioneer in ergonomic design for medical professionals, it is important to have a harmonious, physiological posture that allows natural movements.³ Ideally, the practitioner should use the forearms and avoid use of the back, in particular unnatural torsional movements of the lumbar and cervical spine. In practice, Dr. Beach recommends using the zero concept: to first sit in a comfortable position determining the ideal place and height in terms of shortest working distance, then adapt the position of the patient and instruments to the places considered most comfortable.⁴

The FUE requires a high degree of precision during the surgical procedure. When the forearms are not supported, the muscles supporting the forearms in the upper arms and back become tense, causing pain and discomfort related to muscle fatigue. Therefore, an ideal system supports the elbows and/or forearms (Fig. 61.2 and Fig. 61.3).⁵