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. 2014 Winter;22(4):249-53.
doi: 10.4172/plastic-surgery.1000885.

Follicular unit transplantation for the treatment of secondary cicatricial alopecia

Huawei Shao  1 , Hu Hang  1 , Jin Yunyun  1 , Jiang Hongfei  1 , Han Chunmao  1 , Jufang Zhang  2 , Haiyan Shen  2 , Fei Zhu  2 , Ming Jia  2 , Yuyan Wang  2 , Xiaobo Guo  2
Affiliations

Follicular unit transplantation for the treatment of secondary cicatricial alopecia

Huawei Shao et al. Plast Surg (Oakv). 2014 Winter.

Abstract
in English, French

Background: Cicatricial alopecia encompasses a diverse group of disorders characterized by the permanent destruction of hair follicles and irreversible hair loss. Follicular unit transplantation was developed in 1994. However, large-scale clinical trials are necessary to study follicular unit transplantation for treating Chinese cicatricial alopecia patients.

Objective: To investigate the efficacy of follicular unit transplantation in the treatment of cicatricial alopecia in Chinese patients.

Methods: Patients with cicatricial alopecia were enrolled. The designated recipient area, follicular unit density of the donor site, transplanted density and operative time were recorded. Postoperative follow-up was conducted within six to 24 months; the density of hair in the recipient area was calculated using a Folliscope (Hansderma Co, USA). Patients' self-reported satisfaction and long-term complications were recorded.

Results: Thirty-seven patients were enrolled. Cicatricial alopecia was caused by burns (n=8), trauma (n=21) and plastic surgery (cleft lip and palate repair [n=8]). Burn patients had a significantly larger bald area than the other patients (P<0.01). The operative time was significantly correlated with recipient area. The longest operation was 14.5 h; the largest transplanted area was 96 cm(2). At follow-up, the surviving follicular unit density/transplanted follicular unit density rate was 64.29% to 95.00% (mean 78.96%); the surviving/transplanted (S/T) area was 100% for 30 patients, 90% to 100% for five patients and <90% for two patients. The lowest S/T area was 82.81%. The S/T index was significantly and inversely correlated with operative time. Regarding long-term complications, two patients had postoperative epidermoid cysts that healed with local treatment.

Conclusion: Follicular unit transplantation is an effective method for treating cicatricial alopecia. It is relatively safe and yields satisfactory postoperative results. Extending the results of the present study to Chinese clinical practice is warranted.

Historique: L’alopécie cicatricielle englobe un groupe diversifié de troubles caractérisés par la destruction permanente de follicules pileux et une perte de cheveux irréversible. La greffe folliculaire a été mise au point en 1994. Cependant, des essais cliniques à grande échelle s’imposent pour l’étudier dans le traitement de l’alopécie cicatricielle chez des patients chinois.

Objectif: Étudier l’efficacité de la greffe folliculaire pour traiter l’alopécie cicatricielle chez des patients chinois.

Méthodologie: Les chercheurs ont recruté des patients présentant une alopécie cicatricielle. Ils ont consigné la zone désignée, la densité des unités folliculaires au foyer du donneur, la densité greffée et le temps d’opération. Ils ont effectué un suivi postopératoire dans les six à 24 mois et calculé la densité pileuse du receveur à l’aide d’un folliscope (Hansderma Co, États-Unis). Ils ont consigné la satisfaction des patients et les complications à long terme.

Résultats: Trente-sept patients ont participé. L’alopécie cicatricielle était causée par des brûlures (n=8), des traumatismes (n=21) et la chirurgie plastique (réparation d’une fissure palatine et labiale [n=8]). Les patients brûlés présentaient des zones d’alopécie beaucoup plus importantes que les autres patients (P<0,01). Le temps de l’opération était corrélé avec la zone du receveur. L’opération la plus longue a pris 14,5 heures et la greffe la plus vaste était de 96 cm2. Au suivi, le ratio entre la densité des unités folliculaires survivantes et la densité des unités folliculaires greffées variait entre 64,29 % et 95,00 % (moyenne de 78,96 %). Le ratio entre la zone survivante et la zone greffée (S/T) était de 100 % pour 30 patients, de 90 % à 100 % pour cinq patients et de moins de 90 % pour deux patients. La zone S/T la plus faible était de 82,81 %. L’indice S/T, significatif, était inversement proportionnel avec la durée de l’opération. Pour ce qui est des complications à long terme, deux patients ont présenté des kystes épidermoïdes postopératoires qui ont guéri grâce à un traitement localisé.

Conclusion: La greffe folliculaire traite l’alopécie cicatricielle avec efficacité. Relativement sécuritaire, elle donne des résultats postopératoires satisfaisants. Il faudra étendre les résultats de la présente étude à la pratique clinique en Chine.

Keywords: Cicatricial alopecia; Follicular unit transplantation (FUT); Hair transplantation.

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Figures

Figure 1)
Figure 1)
Calculating the follicular unit (FU) density using a Folliscope (Hansderma Co, USA) FU density detector. A Folliscope FU density detector. B Sampling a patient’s FU density. C Automatic calculation of FU density. D Reporting the generated output
Figure 2)
Figure 2)
Follicular unit transplantation harvest and preparation procedures. A Marked donor strip. B Excised donor strip. C Donor strip divided crosswise into slivers containing one to two rows of follicular units. D Further dissection of the follicular units placed on gauze in saline at 4°C
Figure 3)
Figure 3)
Follicular unit transplantation and follow-up procedures. A Incisions were created with rectangular, chisel-shaped blades. B The follicular units were transplanted using microsurgical forceps. C The density of the follicular units was 35 units/cm2. D Hair density at a follow-up visit
Figure 4)
Figure 4)
Prefollicular unit transplantation (A) and 24-month follow-up visit (B) photographs of a 19-year-old woman who experienced a burn injury 12 years previously
Figure 5)
Figure 5)
Prefollicular unit transplantation (A) and 24-month follow-up visit (B) photographs of a 21-year-old man who experienced a burn injury 15 years previously
Figure 6)
Figure 6)
Prefollicular unit transplantation (A) and 24-month follow-up visit (B) photographs of a 15-year-old girl who experienced a traumatic injury five years previously
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