We began developing the window punch several years ago for personal use. It has the same great features as our serrated punch; most importantly, it has the same sharp cutting edge. We also manufacture the window punch from the same high-quality, hardened steel.
What is new?
- First, a reduced resistance. As a punch enters the skin, resistance begins to increase along the margins, or circumference of the punch. Opening the window reduces surface area, and thus, resistance. Resistance is proportional to the circumference of the punch and the depth of penetration. In short, resistance is a function of the depth of the incision and the diameter of the punch.
Where depth is the depth of punch insertion and D is the diameter of the punch.
Opening the sides of the punch reduces resistance as the punch enters the skin. A reduction in resistance internally allows for easier penetration of the punch with less axial force.
As one incises deeper into the skin surface, the loose outer, free margin length of the graft increases. This free part tends to begin rotating in the direction of the punch, clockwise or counterclockwise. Opening the punch walls also reduces resistance internally, which results in a decrease in graft torsion. Reducing torsion reduces graft spin in the direction of the punch rotation. Reduction in torsion also reduces follicle transection risk.
Opening the punch allows the operator to see the graft during the dissection process. Direct visualization of the follicles during the dissection makes FUE an open procedure for the first time. One can verify the proper position of the punch on the skin with the follicles located in the center of the incision, or to the top, bottom, left, or right of the arc of the incision. One can alter the insertion angle slightly based on the position of the follicles inside the window punch.
Visualization of the tissue during the dissection process gives the operator the option to modify the angle of incision based on the response of the skin to the incision. Insertion of a sharp rotating punch may cause a bend in the superior margin of the incised graft inferiorly. This bend may be centrally located or slightly to the left or right. Continuing the same path can result in transection, including completely transected grafts. If the incision distorts the orientation of the skin, the surgeon can now modify his approach angle based on the reaction of the skin or the wound’s response to the incision.
Should tissue or graft becomes dislodged and located in the center of the punch, the window allows easy removal of this tissue with a set of fine-tip jeweler’s forceps. It is common for grafts to cut deeper than necessary to break free of the adipose and be “sucked” through centrifugal force into the lumen of the punch and begin to spin inside the punch. Should this occur, rotation of the punch should be stopped immediately to dislodge the graft and avoid damage to the follicles from centrifugal force. This is especially important when high rotational speeds are employed. The window punch does not pose any greater risk for graft dislodgement into the lumen of the punch. In fact, the window punch reduces the risk for graft dislodgement and allows for easier removal of grafts should this occur.
The opening of the window starts at a depth of 1mm. Thus, the surgeon has a depth guide during incision. Often, a slower initial incision and limited depth incision to the first 1 mm is necessary because the skin is denser and tougher in the first 1 mm. At a depth, typically below the first 1 mm, the tissue becomes softer and more easily cut. We call this margin the "release point." At the “release point” the incision may change from a slower, cautious incision to a more forceful, quick incision, in many instances. The window gives the surgeon a reference point for the depth of the "release point".
There is a note of caution with the window punch. It is common for doctors to use a 12-ply gauze sponge, similar to the one depicted in this video. The serrated teeth on the punch can grab the 12-ply sponge, and the gauze can begin to spin with the punch. If the surgeon does not quickly stop the rotating punch, the window punch can become disfigured as noted in these photos.
The window punch has all the features of the original serrated tip punch with many new advantages. These benefits are all designed to improve graft quality while enhancing the surgeon's overall FUE experience.
We are transitioning from the solid serrated tip punch to the window serrated tip punch.
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