الفهرس | Only 14 pages are availabe for public view |
Abstract Hair transplantation has been popular as a permanent method for restoring hair loss especially in camouflaging of scarring alopecia by providing restoration not obtainable with other methods like expander or micropigmentation (Barr and Barrera, 2011b). Follicular unit extraction is a new method of hair restoration surgery being firstly introduced by Rassman and Bernstein at 2002 as a better method regarding low scar tissue than FUT technique but in FUE technique the person must have a good donor area specially in large surface area (Harris, 2013, Yoo et al., 2019). Hair restoration surgery in scars is a challenging procedure due to low vascularity and high tissue stiffness that in turn provide a low survival rate of transplanted grafts (Saxena et al., 2016) Full scar history including size, type of healing, healing duration and complications of wound are a very important details which will give a predicted result and survival rate of hair grafts. The timing of hair restoration surgery is important, the scar should be fully mature (pale and soft) and not complicated.pink scars are still immature and morevlikely to bleed during procedure.the golden waiting period for hair transplantation is 4-6 months and the scar should be stable (Barr and Barrera, 2011b). The cause of scarring alopecia is important for result prediction, scarring alopecia due to burn give a better results than that is due to wounds. Complicated wounds will give bad results than non-complicated wounds. Sufficient subcutaneous tissue is important for follicular unit transplantation. Graft survival rate of hair restoration surgery can range from 0 upto 95% in scar tissue (Farjo et al., 2015) Summary 125 Extensive form, complicated scarred tissue and atrophic scars give unsatisfactory results in hair restoration surgery (Ağaoğlu et al., 1999). In most of studies about hair transplantation in scars, the graft was taken from the donor site and implanted in the scarred recipient area without any treatment of the recipient area before hair transplantation. It is known that cicatricial recipient areas do not provide an optimal environment for hair transplant due to tissue stiffness, decreased vascularity and limited underlying subcutaneous tissue, which influence hair graft take and survival. To enhance the graft take and survival rate of implanted follicular units. Many factors can denote the aesthetic outcome of hair restoration surgery in scars.however the most important two factors are availability of donor site (specially in large alopecic surface area) and the quality of recipient scarred tissue.the first factor is constant and can‘t be changed the other factor can be modulated.mature scar with sufficient subcutaneous tissue enhances the graft survival.scarrd tissue can be improved dramatically with microneedling and PRP injection before hair transplantation as a preparation for the recipient scar. Most of done studies worked on the recipient area maybe by microfat grafting, increasing the subcutaneous tissue by dermofat grafting and improving skin quality by CO2 laser. In the current study we used platelet rich plasma 3-5 sessions before hair transplantation and last session was before hair restoration surgery by 5-7 days. Platelet-rich plasma (PRP) is a concentrated form of plasma which contain platelets seven times the amount in normal plasma. Because the underlying disease process in cicatricial alopecia is inflammatory, PRP is a treatment option due to the various growth factors it contains, such as PDGF Summary 126 (platelet-derived growth factor) and VEGF(vascular endothelial growth factor), that influence wound healing, tissue repair, and remodelling of scar tissue. Improvement of the scarred tissue was noticed after microneedling and PRP injection by clinical examination and digital microscope used in the current study. The cause of cicatritial alopecia is an important factor for result prediction as the following; postburn scars showed better results and better graft survival rates than traumatic and incisional scars due to deeper scarring damage to subcutaneous tissue (Jung et al., 2013a) Hair transplantation, after micro-needling and PRP injection, is a promising treatment for post burn alopecia. However, further studies with larger series and a comparative study comparing solo hair transplant on post burn scar and hair transplant after micro-needling and PRP injection are required. |