Standard Magnet Implantation Procedure

Preparation

Before one starts cutting into oneself, a few things need to be addressed and made ready for the procedure: Time, Personal Health, Workspace, and Tools and Supplies.

1. Time

Implanting a magnet is not something you can do properly in a rush. The planning process for the procedure takes time, as do the preparations. Unless you already have a dedicated workspace set up and maintained (Criteria defining a "dedicated workspace" will be provided in another page), plan on setting aside a day to accomplish the requisite preparations and perform the procedure itself.

2. Personal Health

Anyone who has had a surgical procedure performed on them knows that great lengths are taken to prevent infections and illnesses from arising before and during the procedure, and that something as simple as a bout of the flu can force physicians to reschedule the procedure. The same caution must be exercised when performing a magnet implantation. That said, do not perform the procedure if you are experiencing any one of the following conditions or illnesses:

• fever
• flu
• infections of any kind (sinus, ear, or otherwise)
• excessive sneezing (not just an inconvenience, this can cause problems from a contamination standpoint)
• fainting at the sight of blood (if you have an assistant perform the procedure for you, and are properly positioned, this is not an issue)

If you do not meet any of the aforementioned criteria, the next step is to assess the current state of your body from the standpoint of potential risk factors. If you participate in activities which place a lot of strain on the target implant location, make preparations to allow the site to heal before resuming your participation. If you work in a field which is likely to expose the implant site to high levels of bacteria, or water, make note of this, and take the appropriate precautions. In short, make a list of anything likely to cause post-operative complications, and plan the proper counter-measures in advance.

Finally, it's essential that you prepare your body as best as possible for the surgery beforehand, so eliminating stress, maintaining adequate hydration, and rehearsing your post-operative regime can make all of the difference.

3. Tools and Supplies

No one in their right mind would perform heart surgery in a garage, using tools they found lying around. The same logic should be applied to the magnet implantation procedure. Below is the start of a list providing links and prices of the required equipment, and possibly a pre-packaged implantation equipment kit. For now, you can contact Cassox for kits containing nearly everything you'll need.

General supplies

gloves (latex or nitrile), for implementation and aftercare tape (for aftercare if implant was in hand) sterile gauze pad small pair of scissors (optional -- if there were stitches) pair of tweezers (optional -- if there were stitches) butterfly closures (optional)

Sterilization

• Depends on your method, see Sterilization
• Sterilization pouches (if you need to store your tools and/or implant)

Anesthetics

• Depends on your method, see Local_Anaesthetics

Aftercare

• triple antibiotic ointment
• sterile saline (comes in a squirt bottle or you can use contact lens solution)
• adhesive bandages (common brand name is Band-Aids) or gauze and tape or Tegaderm (clear cling wrap for small wounds -- great option)

4. Workspace

It cannot be stressed enough that a sterile workspace is essential for ANY implantation procedure. Specifically, " A 'clean' environment that surrounds an incision... relatively free of microorganisms, in particular bacteria" [1] , also known as a sterile field. Before setting going through all the work needed to sterilize an area, it's important to select a well-lighted area, with plenty of room to work. Keep in mind that you need to have an area to rest your hand during the procedure, an area to keep your tools, and an area to safely discard used tools, and that all 3 must be sterile. "Choose a room where airflow can be blocked. Close any vents and turn off heating or air conditioning. Furthermore, the room chosen should have a non-carpeted hard floor and minimal or no fabric furnishings such as couches or drapes." (Tibbetts, A.L. Blogspot)[2] It's also a must for the field to be level, hard, and stable. Something with a raised edge is also beneficial. After you've selected a suitable location, you can begin to prepare for the operation if you've assembled all the other prerequisite supplies.

5. Preoperative Preparation

Sterilization

Operating Room Preparation of the sterile surgical environment should start 3 hours prior to the time you intend to perform the implantation procedure. Begin this process by trimming your nails and thoroughly scrubbing your hands with a chlorohexidine based cleanser. Pay special attention to the nail bed and the area in close proximity to it. Put on a pair of exam gloves(not surgical gloves) and go about "damp dusting all furniture surfaces with particular attention to horizontal surfaces. After this wet mop the floor. The liquid used for wet dusting and mopping can be made of a Quats solution, a Chlorhexidine solution or even diluted bleach." (Tibbetts, A.L. Blogspot) As stated in the Chemical Sterilization section, the standard for hard-surface and general disinfection is a quats solution, usually in the form of a wipe. After damp-dusting and mopping the room, you should wipe down the area you've designated as your sterile field with quats wipes thoroughly. Switch gloves (if possible) and ensure all the tools you need are accessible and in the appropriate location of the operating environment. Surgical Field 20 minutes prior to the procedure, scrub your hands again with the chlorohexidine cleanser and let the cleanser go about its work. Immediately before you begin the procedure, don the sterile, surgical gloves.

Procedure

2. Implantation

Tourniquet

Once adequate anesthesia has been achieved, loop the hair band tourniquet around the finger a few times. This band will prevent excessive bleeding while creating the incision and undermining the tissue. There isn't a way to gauge whether the band is tight enough until the incision has been made. If its not tight enough blood will flow freely and the second hair band should be looped around the base of the finger at a tightness that will stem blood flow. In most surgeries, there are two primary considerations when it comes to tourniquet use: time and pressure. We don't have to worry about pressure because the fingers are small and the hair bands aren't really capable of pressure to the point of tissue damage. In regards to time, a tourniquet should be used for as short a time as possible. The Association of Surgical Technologists recommends that a tourniquet not be used on the upper arms for more than sixty minutes at a time. I'm going to suggest that a person go for no more than twenty minutes. After twenty minutes, remove the tourniquet and apply pressure and some gauze at the incision site for a minute or so and then reapply the hair band.

Making the Incision

Use a pair of clamps to pick up the scalpel blade and attach it to the scalpel handle. Hold the scalpel as if you were using a writing instrument about 4 centimeters away from where the blade meets the handle. If possible, use the fingers on either side of the target finger to pull the skin taught. Make your incision using the flat edge of the knife rather than the very tip. Remember that you don't have to achieve full depth with the first cut and that it's much better to make multiple small cuts than to go too deep and hit nerve or tendon. The final length of the incision should give at least an extra millimeter on each side, so for a 3mm magnet, go for a 5mm long incision. Proper incision depth warrants a paragraph of its own.The depth of the cut needed is completely dependent upon the skin of the person. It will most likely be between ½ mm and 1mm. A person knows they've achieve adequate depth because the incision can be pulled open revealing the underlying dark red tissue beneath. If the tissue at the base of the incision stays still when the overlying skin is tugged, then you’re definitely deep enough. Remember that it's essential not to cut any of the underlying structure. There really isn't fat or muscle at this location, so you have no room for error. If you cut too deep, your cutting tendon, vessels or nerves. Damage to any of these can be disastrous. Not cutting deep enough simply means that your magnet will at some point pop out, which isn't really all that big a deal. You can always do the process again later, and most likely with better technique due to experience.

Undermining the Wound Edge

The skin edge must now be undermined in order to create the space where the magnet will rest. Undermining is accomplished by freeing the skin from its deep tissue attachments.It is advised to use surgical scissors. The two sides of these scissors can be easily broken apart resulting in a implement that is sharper and more precise than a probe, yet dull enough that it can be used by an inept shaky hand. This tool isn't really used like a cutting implement, but rather more like how a probe would be used. Slip the edge under the skin layer and push it back and forth with pressure to tear apart the connective tissue holding the skin to deeper tissues. It will take some pressure to accomplish this as you are literally tearing the layers of tissue apart. If the prospect sounds terrifying, consider practicing this on a piece of pig skin from the local butcher with the skin intact.

Undermining is performed moving toward the anterior pulp of the finger. It should be large enough that once the magnet is placed, it will not be visible at the base of the incision itself. Undermining is the most laborious and frustrating part of the procedure. The pouch should extend at least the diameter of your magnet plus 2mm away from the incision site. When performing this, you are creating the final position where the magnet will be located. The magnet should be positioned offset from the mid-line of the finger. Even after healing, most people report that direct pressure causes pain. A good implant shouldn't stop you from being able to do pull-ups. If the pouch created allows the magnet to sit 45 degrees away from the mid-line of the finger, then pressure will simply push the magnet to the side without resulting in pain. This step requires the most attention as the lack of a proper pouch will inevitably lead to rejection, while a poorly made pouch leads to an inconveniently place magnet.

Placing the Magnet

Placement of the magnet will likely require a person to go back to the previous step a few times in order to enlarge the pouch. When working on yourself, it really is difficult to get it right in one go. Once the pouch is adequate in size, use a non-ferrous implement such as the back of a disposable scalpel to push the magnet into place. While it's true that using pressure to push the magnet and get it to stay in the pouch creates trauma to the surrounding tissue, it also helps to position the magnet so it's not putting pressure on the healing incision from the inside. The magnet is placed correctly when you can pinch the two sides of the incision site together with minimal pressure without the magnet edge protruding.

Suturing the Wound

Use a 3-0 or 4-0 braided silk suture with a curved needle. Insert the needle 1.5mm away from lateral edge of the wound to a 1mm depth using forceps. Spin your wrist to drive the needle beneath the incision towards where it will exit, 1.5mm away from the medial wound edge. It's important to pause in the middle of this process and use pressure to push the magnet deep into its pouch. If your using a resin coated magnet, you don't really need to worry about scratching it with the needle, but if your using a magnet coated in parylene C alone, scratching the coating with the needle will inevitably lead to rejection later. If using parylene alone, replace the magnet prior to closing the wound. If you end up driving the needle through and its exit point is non-optimal, it's ok to pull it back and reposition.

Once the suture needle is visibly protruding from an optimal exit point, use forceps to grasp the tip and pull it through completely. Pull a good 8 inches or more of suture thread through the wound and then perform a one handed surgical knot. This looks cool, but that's not really the point. A well tied surgical knot does not loosen under pressure or easily become untied. The first knot determines the quality of the stitch. It should be just tight enough that the wound edge touch. Tying it too tightly will pull the edges of the incision to where they overlap, which increases the likelihood of infection, dehiscence, and scarring. Tie the knot just tightly enough that the edges snug together like the incision never happened. Tie a second surgical knot, and then the type of knot from there on is irrelevant. Just make sure to make lots of them. No matter how much attention you pay to taking care of your suture, you will at some point pick something up or doing something without thinking that will put pressure on the wound, so a good suture is near essential.

A suture is almost necessary in order to achieve a clean well approximated site without scarring. For some strange reason though, people who often have no trouble cutting themselves open and creating the pouch... are too afraid of needles to suture themselves. Seriously, you cut yourself wide open so the fear of needles thing doesn't make sense! But, the point of this blog isn't to advocate for people perform this procedure, but rather to help those doing it anyhow to do it safely and with good result.

If you choose not to use a suture, then you can use a medical grade super-glue called Dermabond. Dermabond does a pretty good job at preventing infection as you can form a serious little glue cap right over the incision site. It isn't all that mechanically strong though, so if you use Dermabond, then you should also be using Benzoin tincture and steri-strips. The benzoin tincture is a sticky coating that smells good and really helps the steri-strips stay where you want them. Use two steri-strips over the incision site after application of dermabond. Something to keep in mind is that if you cap the wound in Dermabond, it functions not only to keep pathogens out... it also keeps them in. A nice sutured incision naturally has a bit of seeping that acts to clean the wound from anything that might have been introduced during the procedure. Dermabond traps anything introduced and may increase the likelihood of infection.

Removal of Tourniquet

Use a pair of scissors to snip off the hair band and observe the finger as it re-perfuses. A little bleeding is normal although it should be relatively scant. If the site continues to bleed, apply enough pressure with a piece of sterile gauze to staunch the flow. Hold pressure for a minute or two and then check to see if the bleeding has stopped. The surgical stage is complete.

3. Post Operative Procedure

Dressing the Wound

To dress the site, begin by irrigating the incision with sterile saline. Although large wounds are usually irrigated with pressure, such as with a 10ml syringe, it's unnecessary in this case. Simply pour the sterile saline over the wound and then wipe it away with a piece of sterile gauze. The gauze shouldn't be used directly on the wound, but rather around the edges and always wiped in a direction moving away from the incision. The point of the first irrigation is primarily to remove any blood from the surrounding area. After irrigation apply triple antibiotic ointment directly to the site. Cover with a piece of clean gauze and then wrap tape loosely around the circumference of the finger. Ice (optional) To potentially reduce post operative swelling and bruising, ice the finger immediately afterwards. Some implanters recommend this.

Wound Care (first week)

For the first week it's important to keep the site dry with the exception of saline irrigation. The one disadvantage of a stitch is that it can wick fluid under your skin along with bacteria leading to infection. Put a plastic bag over the finger and wrap it in tape for showering. Repeat the procedure of dressing the wound daily and as needed in order to keep your finger clean. The gauze that covers the wound should be dry so make sure the finger isn't wet from the saline when the gauze is applied. Carry extra triple antibiotic, gauze, and tape with you throughout the day so that you can dress your wound again should it get wet or become soiled. An alternative to gauze and tape would be to use Tegaderm (with or without a small piece sterile pad to cover the wound). Learn more about After Care.

Healing (first month)

Expect full wound healing to take as long a month. Little healing will occur for the first 2-3 days. By day three, proliferation will begin. Proliferation begins with revascularization of the tissue. All of the capillaries that were damaged are being repaired or replaced so its normal for the site to look very red. This isn't necessarily indicative of infection. Around the same time, fibroblast cells move into the area and begin laying down the collagen matrix to bind the incision back together. By day five, if you've kept your incision clean and dry and haven't put any pressure on your wound, you could probably get away with removing the suture. With one stitch 3-5 days is about right, but use your best judgment. Everyone heals differently. Some people wait 7-10 days without complications. The longer the suture is in the increased chance for infection but also the increased healing for the wound. Keep a close eye on the site. After day five, tug on the suture a bit after irrigating it to make sure that the insertion sites are free of infection. If the suture sites begin to get red or if you see any exudate it's better to take the suture out. To remove the suture, clip it as close to the skin as possible on one side and then tug on the other length to pull the suture through. After removing the suture, it's a good idea to apply steri-strips and benzoin tincture. They aren't as strong as a suture, but will help if you accidentally use your hand. Keep the site dressed for one day after removing the sutures. If you notice a portion of the incision remaining open, keep it closed with steri-strips and continue to clean and dress it. It's good to keep the triple antibiotic on the site for at least ten days as it will prevent the tissue from drying out, something which increases the likely-hood of scarring. Assessing for Complications By day five, there shouldn't be an increase in redness. Any redness or swelling, increasing sensation of warmth or pain may indicate that you have an infection or that your body is mounting an immunological response to the implant. If you see swelling and redness, there is one last shot at saving the implant: drain it. You can use a lancet and poke into the wound after cleaning the site well. Assess the drainage closely. If it's just a little cream colored pus, then you have a good chance of having the site heal nicely after draining. If its a copious amount of drainage, or if the drainage is bloody or any other color remove the implant, or see your physician. Most of the time a little infection such as this is not a major problem but there is always the chance of something very bad such as gangrene or necrotizing faciitis. Another very bad sign is if you see stripes of color running down your finger or hand. Cellulitis is always a bad thing, and because the hand is such a delicate mechanism a bad infection can easily lead to loss of function or even amputation.

30 Days to 6 Months Post Procedure

Barring complications or too much playing with your magnet, the tissue should have regained between 50% and 80% of its tensile strength by the end of the first month. Picking up other magnets, particular large strong magnets can still lead to problems as this can occlude blood flow and cause crush injury. Ferrous objects like staples, nails, and metal filings are just fine though. Don't be disappointed however if your not getting much sensation. In fact, a decrease in initial sensitivity is likely. You might have experienced a bit of sensation within the first few days after the procedure, but full sensitivity is regained generally over a 3 to 6 month period. Initial wound healing entails a rapid linking by collagen fibers in a rather disorganized haphazard arrangement. As maturation of the site progresses, the initially disorganized fibers are replaced with well organized ones and the area surrounding the implant will contract rather than looking visibly swollen. After the first 30 days the tissue will begin to soften around the implant. Many of the capillaries and small vessels formed during revascularization will be broken down and the redness of the site will begin to resolve. Nerves will regrow and you'll gradually develop the ability to sense electromagnetic fields.

Another item worth mentioning is the so-called “training” of your magnet. I've read articles where those with magnets “practice” with other magnets in order to increase their sensitivity. Some rationalize it as “forming new connections in brain.” I haven't really found any support for this idea. Perhaps the more one plays with their magnet the more sensitive they will become to the electromagnetic fields around them. Alternatively, perhaps they are just experiencing the subtle increase in sensitivity that naturally occurs as the site heals, matures, and re-innervates. Either way, you won't be able to help yourself; it's a very fun toy, but if you need to justify play you can always tell yourself and others, “I'm training.”

Citations and References

sterile field. (n.d.) McGraw-Hill Concise Dictionary of Modern Medicine. (2002)

Implanting a Magnet III: Procedural Walkthrough. Augmentation Limitless (Blogspot). Jeffrey Tibbetts. (September 2013)

Jack Kingsman’s Magnet Implant http://jacksbrain.com/2014/06/successful-surgery/