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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31827c73d9
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A “French Twist”: Practical Hair Control in Plastic Surgery

Baker, Michelle C. L. M.B.B.S., B.Sc.(Hons.); Fox, Leanne C. J. Dip.H.E.; Davis, Christopher R. B.Sc., M.B.Ch.B.

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Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol, United Kingdom

Correspondence to Dr. Baker, Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol BS16 1LE, United Kingdom michellebaker@doctors.org.uk

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Sir:

Hair control is paramount for optimizing the surgical approach and subsequent wound closure during head and neck surgery, craniofacial surgery, and neurosurgery. Numerous methods have been described, including shaving, parting and clipping, hemorrhoid bands, stapling, Aquagel, Jelonet (Smith & Nephew), beading, foil, and swimming caps.14 Each technique, however, has a number of inherent weaknesses.

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We describe the use of French braiding as a simple, free, and versatile alternative with many positive features. This technique is particularly applicable to patients with longer hair to enable a precise surgical approach, clear operative field, and straightforward wound closure. Braids are adaptable to many surgical approaches, allowing all strands of hair to be neatly controlled away from the surgical incision, particularly for larger volumes of hair. There is no additional trauma to the scalp or hair during the procedure, and the braids may be left in postoperatively for ease of wound care.

Braids are quick and simple to place, can be performed before arrival in the operating room, and have the unique ability to adapt to curved and linear incisions (Fig. 1) or the apices of a Z-plasty–type approach. Braiding is easy to learn, requires no additional expense or equipment, and is straightforward to perform. Simple braids are created by wetting the hair and then separating it into three even strands, crossing the rightmost strand over the middle strand, then the leftmost strand over the middle strand. Additional hair from the left or right side of the braid can be incorporated with each strand placement to create a French braid. The braid will remain in situ throughout the operative procedure without the need to secure the braid ends, provided the hair is wet.

Fig. 1
Fig. 1
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Shaving, while quick to perform, compromises the postoperative aesthetic appearance through transient iatrogenic alopecia, a conspicuous wound, and increased sun exposure to the incision site. In addition, preoperative hair removal is unlikely to reduce surgical site infection.5 Staples create an iatrogenic injury with additional trauma to the scalp and an unnecessary sharps risk on removal. Staples require further intervention for removal, and there is a possibility of neglecting to remove clips at the end of the procedure. They are generally poorly tolerated during local anesthetic procedures, and removal in the clinic can be unpleasant for patients. Aquagel and Jelonet are greasy to use, result in a slippery operative field, and leave hair with a sticky, matted residue postoperatively. They can become mixed with body fluids and are time-consuming to wash out.

For infected scalp surgery cases, braiding has the unique advantage of securing all hair into manageable segments, which helps to decrease the requirement of hair washing before and after the procedure while allowing excellent exposure to the incision site. French braiding is also useful for removing infected expanders (Fig. 2), permitting excellent surgical exposure and control of a large volume hair in easily manageable segments.

Fig. 2
Fig. 2
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Michelle C. L. Baker, M.B.B.S., B.Sc.(Hons.)

Leanne C. J. Fox, Dip.H.E.

Christopher R. Davis, B.Sc., M.B.Ch.B.

Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol, United Kingdom

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

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ACKNOWLEDGMENT

The authors thank the patients who kindly gave their written consent for publication of clinical images.

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REFERENCES

1. Whallett EJ. Part twist and clip. Br J Plast Surg. 2003;56:e840–e841.

2. O'Neill JK, Stone CA. A novel method of hair control during face-lift surgery: Haemorrhoid bands. Br J Plast Surg. 2005;58:e741–e742.

3. O'Neil JK, Lee S. Controlling hair during craniofacial surgery requiring scalp incisions. J Plast Reconstr Aesthet Surg. 2010;63:e288.

4. Chan WY, Laitung JK. Hair control: A quick and simple method—Reply to “A draping technique for scalp operations” and “Secure sterile head drape for head and neck surgery.” J Plast Reconstr Aesthet Surg. 2010;63:e87–e88.

5. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011;9:CD004122.

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