correction of primary cicatricial alopecia原发性瘢痕性秃发的手术矫正课件

Surgical Correction of Primary Cicatricial Alopecia Dr. Ekrem Civas Dermatologist Dr. Anda Aykan - Plastic surgeon Prof. Dr. Muhitdin Eski - Plastic Surgeon 00 90 312 437 07 37 DISCLOSURES No relevant financial relationships or conflicts of interest to declare. VIDEO, PHOTOGRAPHY there is need to cosmetically camouflage the residual scarred areas. With sufficient donor hair, autologous hair transplantation is the only corrective surgery approach to cover the bald patches; provided the disease is stable. Objectives Different considerations have been presented in literature on the question of the optimal minimum stability period before hair transplantation (1 or 2 years). Objectives Can the disease re-activate years later after stability? Publication shows that re-activation of the disease was inconspicuous. There are only few studies in the literature that show long-term results of surgical treatments. Can we state that patients beyond the active stage of PCA are surgically stable alopecia? Objectives Literature on surgical correction of SCA reveal that hair transplantation can be done on the scar tissue in suitable conditions; Sufficient Donor hair No medical contraindications Sufficient blood supply in the scar This background information together with existing literature on similar cases shed a light for us to embark on this research; Method Between 2011 and 2014, 8 patients (5 male 3 female, aged 26-42) with histo-pathological diagnosis of PCA and stable for at least 1 year were enrolled in the study. Method Table: Patients Data Patient No SexAgeDiagnosisStable Yrs Test Date Date of Hair Transplantation Total Graft No. 1M41Pseudopelad720th Oct 2011900 2F27Liken pilanopilaris1201121st Nov 201170 3M42folliklitis dekalvans 528th Nov 2011670 4M26Liken pilanopilaris2201322nd Apr 2013 19 octber 2013 300 1600 5M39folliculitis decalvans since the patients already have existing scars from the disease. FUE method resulted in small wounds at the donor site, patients recovered faster with feeling less pain and discomfort after procedure. With FUE method, the donor hair is used more efficiently For the above reasons, FUE method was preferred even with female patients. Method 0.8 to 1.0 mm diameter punches were used to score the grafts The recipient area was prepared using 0.9 to 1.1 mm diameter lateral slit technique with graft density of 10 to 20 FUs/cm2. Method Classical hair transplant post-op procedures were followed. Follow up of the patients was more frequent than the AGA patients Challenges After medical treatment of PCA, autologous hair transplantation is the most reliable way to camouflage the scars created by PCA. However hair transplantation in PCA has some important medical, surgical and technical challenges encountered as compared to the classical hair transplantation. Challenges Difficulties in diagnosis; Even with extensive examination, accurate diagnosis remains elusive in some cases. It is difficult to distinguish the different types of PCAs on the basis of histologic findings only, especially at their end stages The highest diagnostic yield is procured when histo-pathological and clinical examinations are both considered. Challenges There is no certain clinical and laboratory finding to predict the stability of the disease. Unfortunately, available medical treatment options can only prevent and slow down the progression of the disease and eliminate the active symptoms. Challenges Hair transplantation may be unsuccessful in the patients who are not in stable period. Surgical treatments are recommended after 1 -2 years stable time period after active phase of the disease ends. In the patient with 1 year stable period (Case-2), activation was observed 3 months after test transplantation. Challenges Insufficient donor hair may lead to unsatisfactory cosmetic results. Liken pilanopilaris Test session 416 grafts 6 months post surgery Pseudolapad 1100 grafts 1 years post surgery Pseudolapad 1100 grafts 1 years post surgery Pseudolapad 1100 grafts 1 years post surgery Pseudolapad 1100 grafts 1 years post surgery Diagnosis: Folliklitis Dekalvans Histo-pathological studies show that in other PCA variations only the hair follicle is replaced by fibrous tissue Could this be the reason why hair transplantation in PCA is more efficient than in Secondary Cicatricial Alopecia (SCA)? Conclusions FUE method is ideal for PCA patients Pre-operative evaluation of scarred tissue with regard to blood supply is another important parameter in the determination of suitable candidates. Graft density and amount of adrenaline in the tumescent anesthesia should be determined with regard to the nature of the scar and blood flow through the scar. Conclusion In 7 patients, infection, necrosis or any other complication was not observed following the procedure The graft survival and hair growth progress was not different from the AGA or SCA patients. Conclusion In our opinion it will be safer to do surgical correction after 2-year stable period Conclusion Hair transplantation is the only corrective alternative method for PCA