Hair Restoration Blog

Innovation in Chronic Wound Healing

A new study on hair transplant in chronic wound healing brings new hope for many patients who suffer from non-healing or delayed healing wounds.  The study was conducted by my friend Dr. Francisco Jiménez in Spain. In this research, Dr. Jiménez and his colleague evaluate the effect of hair transplant grafts on improved healing of chronic wounds.

Area reduction in experimental group (black line) that received hair transplant into their ulcers vs. the control group (red line)

The study is based on the fact that epidermal sheets from the hair follicle may help in re-epithelialization of the wound bed.  The investigators reported that healing of chronic wounds progresses faster in skin where healthy hair follicles exist.

This may be explained by the fact that hair follicles are full of progenitor cells (cells that can transform to other types).  In this study 10 patients with chronic wounds (ulcers) of about 36 cm².  Most wounds were present without complete healing for about 10 years. The researchers implanted 20 hair grafts in an area of 2×2 centimeter.  They also used a similar square of non grafted area as control.

After evaluation of the wound in those two areas it was readily apparent that the area receiving hair implants healed much faster at the 18-week end point.  In this particular case the transplanted area of wound (ulcer) healed significantly better than non transplanted area (27.1% vs. 6.5% ulcer area reduction).  The maximum healing has been noted to be 33.5% vs. 9.7% (transplanted vs. control group) reduction at week four.  In further microscopic evaluation, the investigators noted an increase in several wound healing elements such as epithelialization, neovascularization, and dermal reorganization.

This study demonstrates the amazing role of hair follicle grafting into wound that do not heal normally due to a variety of different causes.  The process of transplanting the wound with hair grafts can be done as an outpatient procedure. This new procedure could improve the life style of many people while reducing the financial burden of treating chronic wounds for the society.

Reference:

Jiménez F et al. A pilot clinical study of hair grafting in chronic leg ulcers, Wound Repair Regen. 2012 Nov-Dec;20(6):806-14

Q:

Hi Dr. Mohebi,

I am not sure how rare hair growth after wound healing is in humans, but having done my Master’s in Tissue Engineering I was excited to find out that my condition might be of benefit to science.

I recently lacerated my shin mountain biking and after it healed I have fast growing dark hair around it.  I don’t have much hair on my legs so it was quite a shock.

Anyway, I just thought I would send you an email in case this was important.  Perhaps its more common than the literature states.

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A:

Dr. Mohebi's research on wound healing and hair growth in animal model: Left: right after skin irritation, Right: 42 days after wound healing with longer than normal and de-pigmented hair

This is a great observation you’ve made.  The research team I was on had done some research on animal models a few years ago at Johns Hopkins that showed wound healing can enhance the growth of hair.  That was an incidental finding during some of our wound healing studies.  We noted some gene therapy techniques we used in the process of wound healing might have affected the hair in the animals we were studying.  In order to understand what this exact mechanism was, we did another study and only focused on hair growth.  It was during this particular study we noticed only the wounding of skin can cause hair to grow faster and thicker.

Before we publish our finding in our animal model of wound healing/ hair growth study, Dr. Cotsarelis and his team from the University of Pennsylvania published a very nice article in Nature in 2007: “Wnt-dependent de novo hair follicle regeneration in adult mouse skin after wounding”

This study has never been duplicated in humans, but it is a subject that definitely requires more investigation.  It is possible that with the same mechanism, the wound healing process in humans can affect hair growth.  We do know this won’t happen every time we have an injury in our body.  However, I am interested to know what other elements were happening in your case. Whether you had any medical condition, used medications during the time of injury or after, and how your wound was treated?  I also would like to see some pictures of the area with growing hair!

Q:

Hey there, doc,

It’s been about three weeks since my second hair transplant in Los Angeles. As of this moment, when I bend my neck, there’s a tightness and tension on the back of my head (donor area). Can you tell me if this tightness will ever go away and be back to the way it was before my operation? I really want to be back in the gym doing my jump ropes and abs.

A:

I’d say to give it about three weeks and begin more gentle activities such as jogging, brisk walking, bike riding, or push-ups. As long as you don’t stretch that donor area by looking down (this is important), you ought to be OK.

Activities to stay away from four to six weeks after a hair transplant: wrestling, flag football, basketball, boxing, abs exercises, and surfing or boogie boarding. Make sure there isn’t much strain on the donor area. It’s sensitive and requires protection and non-contact to heal.

Remember: Activities which increase tension between the edges of the healing wound in the donor area, such as lifting barbells or weights and other exercises involving intense bending of the neck are to be avoided. You should wait at least six months for this type of exercise in order to prevent reopening of the wound or stretching and widening of the donor scar.

Over the last few decades, different therapies which effect wound repair have been proposed. The connection between wound healing and hair growth was already proposed by Dr. Catsarelis at the University of Pennsylvania through the WNT pathway (some molecular process that controls would healing and hair growth). Now, we review the emerging fields of gene and stem cell therapy in hair restoration and wound healing.

Gene therapy, initially developed for treatment of congenital defects, is a new option for enhancing wound repair. In order to accelerate wound closure, genes encoded for growth factors or cytokines showed the greatest potential.

The majority of gene delivery systems are based on viral transfection (intentionally contaminating the host cells with a particular virus that insert the desired gene to the target cells), naked DNA application, high pressure injection, or liposomal vectors, etc. Embryonic and adult stem cells have a prolonged self-renewal capacity with the ability to differentiate into various tissue types. A variety of sources, such as bone marrow, peripheral blood, umbilical cord blood, adipose tissue, skin and hair follicles, have been utilized to isolate stem cells to accelerate the healing response of acute and chronic wounds.

Recently, the combination of gene and stem cell therapy has emerged as a promising approach for treatment of chronic and acute wounds. This is good news for prospective hair loss patients: the idea that similar gene therapy techniques can be used to affect the baldness gene by switching the hair loss gene off and on.

This new study was done by Branski et al. at the Department of Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children.