Hair transplantation is the best option for burn scars in hair bearing areas, it is really challenging for the surgeon because the scar tissue behaves differently from the normal skin. The burn scar may be due chemicals, hot fluids, electrical appliances and scars due do traumatic or post surgical interventions. After the acute management of the burn when adequate healing has occurred (usually 4 to 6 months), the loss of hair in particular zones is a constant reminder of the traumatic accident for the patient and also is aesthetically not acceptable.
It is important to discuss with the patients, realistic options with the patients.There are many challenges faced by the surgeon as compared to a normal hair transplant.
1) Reduced blood supply due damage to blood vessels. This does not allow to increase the density and dense packing of follicles as would be expected, because this might lead to necrosis of scar tissue if too many grafts are placed.
2) Small donor area sometimes due to involvement by burn.
3) Reduced elasticity due to fibrosis.
4) Small donor area sometimes due to involvement by burn
Grafts can be taken from scalp/ beard for hair transplant. Scalp follicles have an added advantages of multiplicity of hair per graft and better texture as compared to beard grafts. For facial areas, grafts can be used from bread areas as well to simulate normal architecture. For eyebrows fine thin grafts are chosen or if not available grafts are dissected to individual follicles.
A density of 15-20 FU/cm2 is considered optimal for the 1st session. Overenthusiam to increase the density can lead to necrosis of the recipient site. Also density building in consequent sessions is a better approach than packing of grafts in a single session.
Direction of hair follicles:
Even after significant precaution of placing the grafts in correct angles and direction ,the graft can grow in varied direction and can have a curl because of fibrosis in the burn /scar tissue.
GDepending on the scar, hypertrophic scar needs deeper recipient sites and atrophic scars might require superficial slits.
Yield of grafts:
As compared to the normal hair transplant, the yield is unpredictable because of altered architecture of the skin. In some cases it is good and in some cases it may be sub op-timal.
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Yes. But a realistic expectation and thorough discussion with a trained surgeon is must.
It might require multiple sessions as in each session Follicular units implanted per cm2 are lesser than expected.
Before doing the complete session, a test patch grafting is always a good choice to assess the growth in burn/scar tissue. Once the results are seen it becomes much more predictable to do a full session then.
Some people have postulated that minoxidil causes increased blood supply thereby aug-menting the results.
No. The precautions are similar to a routine hair transplant.
FDue to various problems, chances of failure are there, but with special techniques and expert surgical acumen good results can be achieved.