Hair Restoration, Hair Transplant, Hair Loss Treatment Clinic

Trichophytic Closure Complications

By Jorge I. Gaviria, MD and Colleagues. Atlanta Philadelphia, GA

First introduced in 1975 by Argentinean Plastic Surgeon, Dr. Jose Juri, for the closure of temporal wounds of facial lifting and the temporo-parietal flaps (Juri flaps), (1,2) variations of this closure technique were employed with hair transplant surgery since 2005. (Dr. Frechet, Dr. Rose, Dr. Marzola). (3, 4) At the European Society of Hair Transplant Surgery on May 24, 2007, the authors presented the protocol for a study we initiated regarding our trichophytic closure technique compared to the non-trichophytic technique and complications that may arise.

Although our technique for trichophytic closure following hair transplant has yielded extremely positive results, intra-operative and post-operative complications have been noted. The objective of this study has been to describe our technique, its widespread successful result and the complications associated with this procedure. We have been evaluating the clinical effects, in terms of visual detection, of the surgical wound (donor) closure, comparing trichophytic versus subcutaneous closure. Further, we have been assessing the effectiveness of the technique in secondary, tertiary hair transplant surgeries, procedures in which large sessions (over 2500 grafts) have been harvested and corrective scar procedures.

545 patients have being involved in our study in 5 different countries. 85% were male and 15% female, ranging in age from 17 to 85 years. This patient population was composed of various ethnicities, and continents. Our surgical team utilized Dr. Frechet's technique as described in his 2007 article. (5) Once the donor strip was harvested, a controlled removal of tissue follows with surgical scissors: a thin strip of epithelium (2mm) was removed (lower edge de-epithelialization), as well as the upper end of the hair follicles. Following this resection, undermining of the sub follicular fat tissue was done to loosen the skin, allowing the wound to be free of tension. The width of the undermining corresponds to that of the strip, (example: if the strip's width was 15mm, the undermining width is 15mm). A continuous running suture followed, 2 mm deep and 2 mm apart.

Long term results shows minimal or no scars when trichophytic closure was used. Improvement in the appearance of the donor scar was due to hair growth thorough the scar, making scarring almost undetectable. When the donor width was less than 13 mm, the scar was virtually invisible.

Intra-operative complications were negligible when the physician was properly trained in trichophytic closure. This technique required that the physician employ appropriate hemostasia and master the technique. Specific scissors were necessary in order to obtain the desire result. However, trichophytic closure was more time consuming than subcutaneous closure.

There was a less than 1% (2 patients post-oIierative occurrence of bleeding and hematoma. Other side effects in the later post-operative period included discomfort, ingrown hair, itching, scabs, numbness, pain, peri-lesional redness, inflammation and edema. These symptoms were greater with trichophytic closure than with subcutaneous closure in the first four months post-procedure. When scar revision was necessary, the same side effects were seen as previously described along with cysts and hair growth parallel to the surface of the scar

Complications from trichophytic closer generally occurred not from the surgery but from the lack of skill on the part of the improperly trained physician. With more medical doctors becoming involved in hair transplant surgery, improved training techniques and credential requirements should become essential. Generally, after the fourth post-operative month, trichophytic closure yielded better cosmetic results than subcutaneous closure. Trichophytic closure created a less detectible scar as hair grew in the area of the scar. The scar was virtually undetectable when donor width was less than 13 mm, In most cases (over 90%), regardless of the number of surgeries, the patients age, ethnicity and hair quality, trichophytic closure demonstrated noticeably better results to the naked eye.