Distinct Patterns of Hair Graft Survival After Transplantation Into 2 Nonhealing Ulcers: Is Location Everything?

Abstract

BACKGROUND Studies highlighting the role of hair follicles (HFs) in wound healing have raised the challenge of bringing this knowledge to clinical applications. A successful translation is the transplantation of scalp HFs into chronic wounds to promote healing. OBJECTIVE To characterize scar formation and hair growth in nonhealing ulcers after transplantation. PATIENTS AND METHODS Nonhealing ulcers were treated with hair transplantation to promote wound healing. Hair follicles were harvested from the patient's scalp and inserted into the wound bed. Wound repair and hair growth were assessed clinically. Further analyses were performed in situ, using biopsies from the central and peripheral scar. RESULTS Rapid wound closure and differences of scar quality and hair growth between the central and peripheral wound areas were observed: the periphery healed with no hair shaft survival and an almost scarless appearance, the center healed with a fibrotic scar, with some hair shaft growth. In situ analyses revealed differences in dermal remodeling and collagen formation between central and peripheral scar areas. CONCLUSION Besides confirming the effectiveness of this therapy to promote wound healing in human skin, location-dependent disparities in scar quality and hair growth raise the intriguing question whether they are due to clinically important differences in mechanical forces and/or wound microenvironments between ulcer center and periphery.

Can fractal dimension analysis be used in quantitating collagen structure?

“…There was no significant difference between the centre of scar tissue and the margin, although there was a higher D in the margin area, suggestive of the higher density at the margin area (Figure 1). The trend was consistent with the study of Alam et al 23 and our previous research 24 . In Alam et al study, the differences came from the components, which was composed of the dermis; while the differences from strain and the orientation of collage fibres in our previous research.…”

Harnessing the Secretome of Hair Follicle Fibroblasts to Accelerate Ex Vivo Healing of Human Skin Wounds

“…For example, scalp skin containing large terminal hair follicles has superior healing compared with trunk skin, making it a gold standard site for harvesting skin for split thickness grafts (Mimoun et al, 2006;Weyandt et al, 2009;Wyrzykowski et al, 2015). Grafting of hair-bearing scalp skin into chronic venous ulcers has also been shown to promote wound closure, over and above closure observed when skin plugs from abdominal skin (containing small vellus hair follicles) are used (Alam et al, 2019;Jiménez et al, 2012;Martínez et al, 2016). Although both of these aforementioned studies are in human skin, mouse skin containing hair follicles in an active growth state has also been shown to heal quicker than skin with hair follicles in a resting state.…”

Trasplante de folículos pilosos en el tratamiento de úlceras crónicas. ¿Mito o realidad?

“…Correspondencia: Medico; email: mpsandrita@hotmail.com La curación de las úlceras crónicas constituye un reto para los profesionales sanitarios. En los estudios de los últimos años se ha sugerido el trasplante de folículos pilosos para acelerar la curación de las úlceras crónicas (1) .…”

“…En el estudio de Alam y colaboradores (1) , realizado en 2019, se evaluó el trasplante de folículos capilares del cuero cabelludo para promover la curación de las úlceras crónicas de difícil cicatrización de diversas etiologías. Al trasplantar los folículos en el lecho de la úlcera, los autores observaron un cierre rápido (a los 10 días del trasplante hubo una notable reducción de la inflamación y reepitelización parcial.…”