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Distinct Patterns of Hair Graft Survival After Transplantation Into 2 Nonhealing Ulcers

Is Location Everything?

Alam, Majid, PhD*,†,‡; Cooley, Jerry, MD§; Plotczyk, Magdalena, MSc; Martínez-Martín, María Soledad, MD; Izeta, Ander, PhD#; Paus, Ralf, MD**,††; Jimenez, Francisco, MD*,†,‡‡

doi: 10.1097/DSS.0000000000001748
Original Article

BACKGROUND Studies highlighting the role of hair follicles (HFs) in wound healing have raised the challenge of bringing this knowledge to clinical applications. A successful translation is the transplantation of scalp HFs into chronic wounds to promote healing.

OBJECTIVE To characterize scar formation and hair growth in nonhealing ulcers after transplantation.

PATIENTS AND METHODS Nonhealing ulcers were treated with hair transplantation to promote wound healing. Hair follicles were harvested from the patient's scalp and inserted into the wound bed. Wound repair and hair growth were assessed clinically. Further analyses were performed in situ, using biopsies from the central and peripheral scar.

RESULTS Rapid wound closure and differences of scar quality and hair growth between the central and peripheral wound areas were observed: the periphery healed with no hair shaft survival and an almost scarless appearance, the center healed with a fibrotic scar, with some hair shaft growth. In situ analyses revealed differences in dermal remodeling and collagen formation between central and peripheral scar areas.

CONCLUSION Besides confirming the effectiveness of this therapy to promote wound healing in human skin, location-dependent disparities in scar quality and hair growth raise the intriguing question whether they are due to clinically important differences in mechanical forces and/or wound microenvironments between ulcer center and periphery.

*Mediteknia Skin and Hair Laboratory, Las Palmas de Gran Canaria, Spain;

Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain;

Monasterium Laboratory, Münster, Germany;

§Carolina Dermatology Hair Center, Pineville, North Carolina;

Department of Bioengineering, Imperial College London, London, United Kingdom;

Department of Morphology, Universidad Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain;

#Biodonostia Health Research Institute, Donostia University Hospital, San Sebastian, Spain;

**Centre for Dermatology Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom;

††Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida;

‡‡Grupo de Patología Médica, Instituto Universitario Investigación Biosanitaria, Universidad Las Palmas Gran Canaria, Las Palmas, Spain

Address correspondence and reprint requests to: Francisco Jimenez, MD, Clínica Mediteknia, Av. Alcalde Ramírez Bethencourt 20, Las Palmas de Gran Canaria 35004, Spain, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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