Haemorrhage, vascular and nerve damage is a risk of strip excision?? can we see some of these implications in patients? what are the chances of this to happen?

I can reflect on these from only experience in my practice:

1. Bleeding after surgery — I sometimes see some wound ooze beyond a day after a surgery (I would guess 1 in 300 patients). I handle this with a simple pressure dressing over the donor wound. Bleeding is never a problem beyond a day in the recipient area.
2. Bleeding significantly during a surgery (by “significantly”, I mean enough to impact blood pressure - more than a few ounces of blood) — Risk for this is close to zero. Every patient bleeds during the surgery as the scalp is very vascular (might lose a few ounces of blood), but it should not be meaningful bleeding that risks anything. Bleeding may be a problem if a patient is on anticoagulants, Aspirin, or if they might have a clotting/bleeding disorder that stops blood from coagulating (this last one should be known by taking a good history from a patient for hemophilia).
3. Vascular damage — There is no risk of direct vascular damage in a normal person unless the patient has had many scalp reduction procedures or many hair transplant procedures, or the surgeon does not have experience in doing this type of surgery.
4. Nerve damage — There are two types of nerve damage that may follow a hair transplant. The fine cutaneous nerves are cut in almost everyone both in the recipient area and the donor area. This might leave some numbness above the wound and this usually disappears in days or weeks. The second type of nerve injury occurs when and if the surgeon accidentally cut a major nerve (’greater or lesser’ occipital nerves). This is a surgical error in technique when it occurs. In my practice, I have never seen it in a surgery I have done, but I have seen this injury in patients who came to me from other doctors who may not have been skilled surgeons in the first place.

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