I just visited a doctor who took me into a surgery and showed me nails in the head of a patient. He said that these kept the wounds open and makes the graft placement easier and produced less damage to the skin and hair. He also told me that he used a multibladed knife to harvest the grafts. I thought I read somewhere that these instruments cause damage. Can you explain what I am being told?
These nails that you are describing are something that was invented by Dr. Manny Marritt in the mid-eighties to make the placement of smaller grafts easier. Within a year, he abandoned the use of these dilators as his staff built the skills to not need them anymore. He concluded that these dilators did not have great value to anyone other than the novice. I did try them early on in my practice, but I quickly abandoned their use within a month. For more information on dilators, including a photo of what they look like, please see this dilators page.
After I designed the 2 bladed knife with the offset of 30 degrees, I built a multi-bladed knife with variable settings to it. I eventually found that when I used the final design on the first 9 patients, the results were decent (I estimated the loss at about 15%). Then on the 10th patient, I had a follicular holocaust with a loss factor of 70%. Fortunately, on these first 10 patients, I only used it on a limited area, but the high transection rate on this 10th patient said to me that inconsistency was going to be the problem. If I could do it 9 times right and then 1 time wrong, the technique was flawed.
This clinical research was done by me in 1992-1993 when cutting was a manpower problem that I eventually solved with a larger and better trained staff. The multi-bladed knife was the wrong answer to this problem and that is my final opinion on the subject. With multi-bladed knives, the labor that the doctor saves does not offset the hair that is killed off. I believe anyone who uses such instruments today are subject to the same type of variables.