follicular unit extraction as a method of hair transplantation in cicatricial alopecia

The study will include 20 patients with cicatrical alopecia.Patients will be randomly assigned into two groups:Group (A):include ten patients will undergo (FUE) alone.

Group (B): include ten patients will undergo(FUE) and (PRP).3-Surgical technique:

• Preoperative Investigations including complete blood count, coagulation profile and hepatitis viral markers.

  1-Group(A): will undergo (FUE)

• Washing the scalp with antiseptic shampoo before the procedure.

• Tumuscentanaesthesia:The donor area is anesthetized with a lidocaine 1% solution diluted with 20 cc saline in addition to adrenaline.

• Creation of micropunches(0.7-1 mm) using micromotor.

• After removal of the punch,the follicular unit is extracted with Jweler's forceps.

• Extracted grafts are then placed on chilled saline gauze for maximum four hours until ready for transplantation.

• The recipient area is prepared with rectangular scalpel blades 1mm or hypodermic blades 0.9 mm.

• Implantation using fine tipped jweler's forceps.

• Finally, receptor and donor areas will be softly cleansed with saline and crepe bandage is applied.

  2-Group (B): FUE+PRP

• The same procedure will be done but grafts will be placed in Prp solution.

• Prp session one week before transplantation then monthly for 3 monthes after (FUE).

• Preparation of PRP

• 10 cc blood will be aspirated in test tube contained a modified solution of anticoagulant,called acid-citrate-dextrose type (ACDA), in which the physiological pH will reached to preserve the platelet integrity.

• The first spin of whole blood sample will be at 2500 rpm for 4 minutes

• The second spin at 4000 for 20 minutes for obtained plasma.

• Platelets are separated as a pellet at the bottom of the tube from platelet-poor plasma (PPP) above. The platelet-rich pellet is resuspended in remaining amount of plasma. The resulting suspension is used as PRP.

• Prp is injected in the recipient area. 4-Follow up:

• Follow up clinically by digital photographs and trichoscopy 1 week after operation, after 3 months and after 6 months.

Inclusion Criteria:

• • Patients with unacceptable visible scarring alopecia.

  • Adequate donor area.
  • patient free of signs of disease activity evidenced by trichoscopy.
  • Patients having inadequate laxity for a strip excision (too tight skin).
  • When previous scars of strip surgeries make further strips impossible.

Exclusion Criteria:

• • Inadequate donor area.

  • Signs of active disease or infection.
  • Patient who is not willing for long sessions for several hours or multiple sessions as needed due to the slowness of the process
  • Contraindications for surgical procedure as bleeding tendency.
  • Contraindications for PRP as (cardiovascular, autoimmune disorders, hematological disorders and neoplasms).