History: This is a 31 year old male with a history of hospital acquired MRSA infection to his scalp following colorectal surgery in 2014. There has been no progression or improvement of his hair loss one month after hospital discharge in 2014. Scalp biopsy in 2016 showed no continuing infection and blood and skin cultures were negative. In February 2016 he presented to our clinic with complaints of hair loss in his frontal forelock and midscalp. Examination showed scarring alopecia, with no evidence of AGA. Donor area showed excellent hair density at 85 FU/cm2 and hair caliber was estimated at 70 microns.
Plan: Test Case April 2016
Our plan was to initially test the scar for blood supply with a small case of 100 grafts. Grafts were harvested using FUE technique, with a 0.8 mm sharp punch, and placed with Hans Lion Implanters. A 1.5 cm by 1.5 cm box was marked in purple to show the area for the test case.
Surgeon: Michael A, Vories, MD | Location: Charlotte, NC & Charleston, SC | Website: carolinahairsurgery.com
Our plan was to initially test the scar for blood supply with a small case of 100 grafts. Grafts were harvested using FUE technique, with a 0.8 mm sharp punch, and placed with Hans Lion Implanters. A 1.5 cm by 1.5 cm box was marked in purple to show the area for the test case.
The patient followed up with us at the 6 month post-op mark, where the grafted area was determined to grow 99 out of the 100 grafts placed. Left to Right – Test grafts implanted, grafted hairs growing at 3 months, graft hair count, top view.
Based upon this result, we planned on a FUE case of 2500 grafts to give the illusion of fullness in the affected area. Photos below show the six month follow-up visit. In October 2016 we scheduled his one day, 2500 FUE graft procedure. We started the case at 7 AM, with graft harvesting taking 3 hours with no complications. Graft placement began at 11 AM, and finished at 3:30 PM. Photos below show the grafts and donor area immediately post-surgery.
Immediate post-op – 2500 FUE hair grafts, top and donor area.
The patient came in for his two week post-op follow up, with the donor area healed and grafts beginning to show evidence of expected telogen effluvium.
Summary:
At the six month post-op mark the patient came in for his second follow up visit, with no complaints of pain, numbness, or itching. We will continue to follow this patient at the one year mark, with expectations of continued improvement in density and transplanted hair caliber. Summary-
Although the patient is very happy with the preliminary results of this case, this case also shows the effectiveness of the FUE procedure. 99 out of 100 grafts were clearly growing at the six month post-op mark, and this is into scar tissue, where we would expect a diminished graft survival.
Back and top at 6 months post-op
Top and front 6months post-op.
