Hair Transplantation: Management of Donor Area

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Abstract
Hair transplantation entails the removing of a strip of permanent hair from the occipital scalp and reimplanting it piecemeal into the recipient area. Methodologies for effecting this are reasonably complex and have undergone many changes and improvements over the years. The simplest part of hair transplantation, at least in theory, is the removal of the donor strip and closure of the resultant defect. Unfortunately, however, the improvements that have taken place in hair transplantation in general have not spilled over into improved donor area outcomes. Unsightly donor scars and fibrosis are still not only with us, but are possibly even more pervasive than ever. One explanation given for deteriorated donor sites is the harvesting of relatively greater numbers of grafts. But is this the whole story? To describe some technical aspects of donor area management consistent with harvesting the best possible donor strip, while leaving an inconspicuous scar and preserving the viability of the residual tissues for subsequent harvesting. In 1994 a clinical research project designed to determine what technical surgical modalities are optimal for excising and reconstructing scalp tissues was commenced. This was done with particular reference to the donor area in hair transplantation. The study involved more than 1000 scalp operations using various techniques and instrumentation, and comparing and contrasting results. The best results were obtained when tissues were least traumatized. Tension generated at wound closure was found to be the main culprit in determining less than optimal residual donor sites. Notably improved postharvesting donor sites are most likely to result when measures are taken to ensure minimal trauma by taking definitive steps to combat tension in the tissues. Modest undermining combined with deep plane fixation facilitates channeling of tension vector forces from at-risk superficial tissues into nonundermined tissues and deep tissues, each of which is optimally equipped to withstand the adverse consequences of tension.