Evaluation of a Novel Graft-Holding Solution in Hair Transplantation: A Randomized Controlled Clinical Study

BACKGROUND

Hair transplantation has become a popular choice for alopecia treatment; however, postsurgical hair shedding still annoys both patients and surgeons.

OBJECTIVE

To explore the impact of graft-holding solution on postsurgical hair shedding and testify the protective efficacy of histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine (HTK-AD).

METHODS

There were 240 patients enrolled in the study, and the follicles were placed into either HTK-AD or Ringer solution (RS). Masson staining and live/dead staining were performed to evaluate graft morphology and apoptosis levels, respectively. The between-group comparison of postsurgical graft shedding, survival rate, complications, and patient satisfaction was performed.

RESULTS

Grafts in HTK-AD maintained organized dense collagen construction and higher cell viability, but those preserved in RS became soft, which hindered implantation. Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine significantly reduced the incidence of postsurgical hair shedding (73.81% vs 95%), delayed shedding onset, and diminished shedding amount versus RS ( p < .05) when ≥3,000 grafts were transplanted. The shedding duration was shortened, and hair regrowth started earlier in HTK-AD versus RS ( p < .05); thus, satisfaction was increased. The final survival rate showed no difference between 2 groups.

CONCLUSION

Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine is superior to RS for hair graft preservation because it improves graft viability and alleviates postsurgical shedding.

Follicular Unit Extraction (FUE) Hair Transplant: Curves Ahead

The hair transplant has become widely popular aesthetic procedure. Follicular unit transplantation (FUT) and follicular unit extraction (FUE) are two commonly used and accepted techniques. FUT requires excision of strip of tissue from occipital donor area leading to linear scar. To overcome scarring and other complications of FUT, FUE technique has been attempted which involves harvesting of small individual follicular units. Hair transplantation has been successfully used in correction of alopecia, cleft lip scars, post-burn or surgical scars, vitiligo and as an adjuvant to other maxillofacial procedures. FUE demands greater skills and orientation but can yield excellent results in experienced hands. Several maxillofacial surgeons have incorporated hair transplantation procedure in their aesthetic practice successfully. Sound knowledge of surgical technique, armamentarium and proper surgical planning are essential for desired results. The aim of this article is to explain FUE technique, risk and complications, holding solutions and other associated factors in detail. A simple protocol has been put forth for reference and for better understanding of the technique.

How Long Can Hair Follicle Units Be Preserved at 0 and 4°C for Delayed Transplant?

BACKGROUND

Preservation of hair follicle units for the purpose of delayed transplant will help us graft thousands of hair grafts at one session, even in a clinic with fewer assistants and less equipment.

OBJECTIVE

This study was undertaken to evaluate and compare the viability of hair follicle units preserved at 0 and 4 degrees C for various periods.

MATERIALS AND METHODS

Cell cultures and transplant of hair follicle units into athymic mice were performed.

RESULTS

Outer root sheath cells could be cultivated in 96% (0 degrees C group) and 92% (4 degrees C group) of the hair follicles after 24 hours of preservation, whereas 85% (0 degrees C group) and 79% (4 degrees C group) of the follicles implanted into the mice regrew well after the same period of preservation. Then, in both the 0 degrees C and the 4 degrees C group, these rates decreased significantly with length of preservation in cell cultures and mice transplant; however, 0 degrees C seems better than 4 degrees C for preservation of grafts (p<.05).

CONCLUSION

Grafts are better preserved at 0 degrees C instead of 4 degrees C. When delayed transplant is an option, it should be completed within 24 hours and no later than 48 hours.

Induction of vascular endothelial growth factor messenger ribonucleic acid expression in stored micrografts by aminoguanidine

BACKGROUND AND OBJECTIVES

Aminoguanidine (AMG) has been found to inhibit apoptotic cell death in hair follicle micrografts and improves the viability of isolated micrografts during the storage period in hair restoration surgery. In this study, we investigated the effect of AMG on messenger ribonucleic acid (mRNA) synthesis of growth factors in stored micrografts and primary cultures of follicle-derived cell populations.

METHOD

Hair follicles were obtained from 10 different patients undergoing routine micrograft transplant and were stored for 5 hours at room temperature in phosphate-buffered saline containing different concentrations of AMG. After a culture period of 72 hours, quantitative changes of mRNA for basic fibroblast growth factor (bFGF), insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor (VEGF) were determined by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Primary cell cultures of dermal papilla and outer root sheath cells were stimulated for 72 hours with AMG followed by RT-PCR measurement of growth factor mRNA.

RESULTS

A dose-dependent induction of VEGF mRNA could be demonstrated in stored micrografts after stimulation with AMG (unstimulated: 1.0 [0.7-2.2]; AMG 10 pg/mL: 5.6 [3.1-9.7], p < .05; AMG 50 pg/mL: 6.9 [5.7-10.0], p < .05; AMG 100 microg/mL: 17.1 [14.1-22.3], p < .001). Expression of bFGF mRNA and IGF-1 mRNA levels was not influenced by AMG stimulation. Stimulation of cultured dermal papilla and outer root sheath cells demonstrated 14-fold induction of VEGF mRNA by AMG in outer root sheath cells (unstimulated: 1.0 [0.8-1.4]; AMG 100 pg/mL: 14.0 [12.5-16.1], p < .01), and no changes in VEGF mRNA levels were detected in dermal papilla cells.

CONCLUSIONS

Our study demonstrated induction of VEGF mRNA in stored micrografts by AMG. Although the clinical relevance in post-transplant hair growth and wound healing needs further evaluation, the possibility of actively influencing growth factor production in isolated micrografts during the storage period is the basis for the development of hair follicle growth-promoting storage solutions in the future.

Is delayed micro-graft hair transplantation possible?--evaluation of viabilities of hair follicles preserved in two storage media

BACKGROUND

Preservation of hair grafts for the purpose of delayed transplantation would allow use of thousands of hair grafts at one time.

OBJECTIVE

To evaluate the viabilities of hair follicle units preserved in DMEM and Ringer's solution at 0 degrees C for various periods.

METHODS

Cell cultures and transplantation of hair follicle units into athymic mice were used.

RESULTS

Outer root sheath cells could be cultivated in 95.8% of those follicles preserved in Ringer's solution, and in 86.7% of those preserved in DMEM culture medium (p < 0.01). In 84.5% of those preserved in Ringer's and 72.5% of those preserved in DMEM for 24 h, hair follicles grew well after implantation into an athymic mouse model (p < 0.05).