Feily’s method as a new mode of hair grafting in prevention of scalp necrosis even in dense hair transplantation

Abstract

Hair restoration is a safe procedure and most of its associated complications are preventable by the surgeon and/or the patient. Recipient area necrosis is rare but arises when an increased number of recipient grafts are utilized and de-vascularization of the scalp occurs. The aim of this study was to investigate and compare all cases and pictures reported in main search engines and Iranian centers of hair transplant to find the dangerous zone of necrosis and to provide a new method for prevention of necrosis. Pictorial analysis of this study revealed that the majority of necrosis (14 of 18) occurs in central region of the scalp and is inclined, particularly, to the right parietal aspect of the scalp. Accordingly, a case series was done and a new method for prevention of scalp necrosis even in dense packing transplantation was discussed.

Using Feily's method prevented scalp necrosis in three patients incline to the scalp recipient necrosis; what is new in prevention of scalp necrosis?

“…Predisposing ingredients are diabetes mellitus, smoking, atrophic skin damage, preexisting recipient‐site scarring, or prior scalp surgery (Konior, ). Potential technical factors associated with the recipient‐site necrosis are large openings, mega‐sessions, dense packing, epinephrine solutions injected directly into the recipient site, and deep slitting (Feily & Moeineddin, ; Konior, ; Loganathan et al, ; Nusbaum & Nusbaum, ). It has been suggested that darkness can be a warning of sudden scalp necrosis and may outline potential danger zones (Feily & Moeineddin, ).…”

“…Potential technical factors associated with the recipient‐site necrosis are large openings, mega‐sessions, dense packing, epinephrine solutions injected directly into the recipient site, and deep slitting (Feily & Moeineddin, ; Konior, ; Loganathan et al, ; Nusbaum & Nusbaum, ). It has been suggested that darkness can be a warning of sudden scalp necrosis and may outline potential danger zones (Feily & Moeineddin, ). Accordingly, appropriate rest and re‐perfusion time is the key point of prevention of scalp necrosis.…”

“…Surgical complications often categorized as those which occur in the donor site, such as keloid formation, wound dehiscence, necrosis, hypoesthesia, and infection and those which occur in the recipient site such as poor hairline restoration, chronic folliculitis, and necrosis (Feily & Moeineddin, ). In this paper among recipient area complication, we focused on recipient area necrosis that arises when an increased number of recipient grafts are utilized and de‐vascularization of the scalp occurs as a result of the large wound area due to the dense packing splitting of recipient skin.…”

Complications of Hair Transplantation

“…Occasionally, very nervous patients faint or feel faint during the procedure, but this can be managed by simple measures such as lowering the head between the knees or laying the patient in a prone position [16].…”

“…Occasionally, for extensive areas of necrosis, scalp expansion may be required for repair. In the treatment of tissue necrosis, hair transplantation can be performed after recovering tissue necrosis [16].…”