Sharp and Hybrid Punches: A Detailed Comparison of Different Quality Control Markers

Introduction: Low transection rate and high availability of usable grafts is very important for the surgeon performing FUE. Prior studies have shown a decrease in transection rate using the blunt over the sharp punch. The hybrid punch developed by Devroye with a flat cutting surface has clinically been shown to also improve the quality and yield of grafts compared to a sharp punch. Objective: The goal of this study was to compare both the sharp and hybrid punch in terms of total grafts available and transection rate. Study Design: This was a multi-center, side-by-side study looking at the same number of grafts removed via follicular unit excision (FUE) with the sharp and hybrid punches. Experienced physicians in both techniques removed grafts using the same-sized punch from similar areas of the scalp and recorded the number of graft extraction attempts, grafts obtained, and transection rates. From this information, a comparison of punches was undertaken looking at complete grafts available and the transection rates. Conclusion: There was an overall higher yield of grafts obtained using the hybrid punch. Also, there was a nearly 50% reduction in the transection rate of the hybrid over the sharp punch. The selection of punch type is important for the physician desiring to maximize the total number of grafts and minimize transection in their patients.