- Email: [email protected]
Follicles first
Accepted Manuscript Follicles First Siún M. Murphy, MB BAO BCh BA MRCS FRCS (Plast), Consultant Plastic Aesthetic and Reconstructive Surgeon, J.O. Connor, MB BCh BAO FRCS RCPS Glasg FRCS Edin FRCS Eng FRCSI, Consultant General Surgeon, Maurice P. Collins, MB BCh, BAO DLO FRCSI FRCS FRCSEd, Consultant General Surgeon PII:
S1748-6815(17)30021-9
DOI:
10.1016/j.bjps.2016.11.032
Reference:
PRAS 5209
To appear in:
Journal of Plastic, Reconstructive & Aesthetic Surgery
Received Date: 22 November 2016 Accepted Date: 22 November 2016
Please cite this article as: Murphy SM, Connor J, Collins MP, Follicles First, British Journal of Plastic Surgery (2017), doi: 10.1016/j.bjps.2016.11.032. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Follicles First
RI PT
Siún M Murphy (corresponding author) MB BAO BCh BA MRCS FRCS (Plast) Consultant Plastic Aesthetic and Reconstructive Surgeon Blackrock Clinic, Blackrock, Co Dublin, Ireland Hair Restoration Blackrock, Samson House, Blackrock, Co. Dublin, Ireland [email protected]
SC
J O Connor MB BCh BAO FRCS RCPS Glasg FRCS Edin FRCS Eng FRCSI Consultant General Surgeon Hair Restoration Blackrock, Samson House, Blackrock Co Dublin, Ireland
M AN U
Maurice P Collins
MB BCh, BAO DLO FRCSI FRCS FRCSEd
Consultant General Surgeon Hair Restoration Blackrock, Samson House, Blackrock Co Dublin, Ireland
TE D
Conflict of Interest Statement
The authors declare that there is no conflict of interest to declare.
EP
Financial declaration
AC C
The authors declare that there was no funding received for this research.
ACCEPTED MANUSCRIPT Zoom in for the bigger picture. Thinking of follicles first in reconstruction of hair bearing skin. SM Murphy, J O Connor, MP Collins Sir,
RI PT
We congratulate the authors on their recent publication, “Beard Reconstruction: a Surgical Algorithm” (1). This is a very challenging area within plastic and reconstructive surgery that impacts on a patients’ sense of sense of wellbeing and self-esteem as well as on their social interaction. Loss of hair bearing tissue in the head and neck can result from surgery, trauma including burns, tumour ulceration and infection as well as some destructive dermatological disorders.
M AN U
SC
Achieving optimal aesthetic results in these patients in a cosmetically sensitive area such as the face is a challenging area. The difficulty in reconstructing these facial subunits is evident in the multitude of complex reconstructive techniques utilized to resurface the facial defect in practices and in the resulting literature. Despite recent advances in microsurgical techniques and free tissue transfer, achieving long-term results remains a challenge, with the additional effect on the donor region and its added surgical challenges.
TE D
The authors correctly point out that only a few donor sites are available to reconstruct these facial hair bearing areas, but to our surprise do not mention or utilize the most abundant supply of follicle rich skin – the posterior scalp. Locoregional and pre-expanded flaps are used to great effect in this case series, and certainly the authors can be commended for this. The series however shows the following defects requiring hair-bearing reconstruction:
EP
Defect Moustache region (philtral, post cleft repair) Philtrum post BCC excision Buccomandibular region post acne scarring Burns to beard and moustache
Reconstruction Local flap Pre-expanded FC temporalis flap Pedicled temporal flap Pre expanded pedicled scalp flap
AC C
While the surgical results are excellent, the procedures are not without their (albeit temporary) disfigurement with pre-expansion or pedicles, and their associated potential co-morbidities. In our experience, all of these defects can be dealt with to excellent effect with the Follicular Unit Transplantation. This technique was first described by Hodara in the late nineteenth century, and then by Okuda in 1939 with a publication of five articles entitled “Clinical and experimental study of living hair transplantation” in the Japanese Journal of Dermatology in 1939, describing 200 cases of reconstruction in cicatricial and congenital alopecia. No serious interest was expressed in hair transplantation until Orentreich’s publication on its use in androgenic alopecia in 1959(2). has been described in the literature before(3). Hair can be successfully harvested under local anaesthetic under strip excision (FUT) or Follicular Unit Extraction (FUE). This follicular concept was first described in 1984 (4) as hair
ACCEPTED MANUSCRIPT transplantation techniques develop, has revolutionized the care of many patients to date requiring this type of reconstruction. A publication in 2011 by Pribaz et al (5)mentioned plug grafts in 1 of their series of 34 patients, and a strip graft in another patient. We believe that all of the patients in both these papers could have been treated with either FUT or FUE procedures, significantly reducing their operative time and morbidity.
RI PT
It is our opinion that all plastic and reconstructive surgeons should understand the basic concepts of follicular transplantation when approaching patients requiring reconstruction of a hair bearing area of the head and neck. Even when the unit does not provide this service, the practitioners should consider hair transplantation as part of the multidisciplinary approach to these patients.
M AN U
SC
Yours etc,
AC C
EP
TE D
References 1. Ninkovic M, Heidekrueger PI, Ehrl D, von Spiegel F, Broer PN. Beard reconstruction: A surgical algorithm. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2016;69(6):e111-8. 2. Orentreich N. Autografts in alopecias and other selected dermatological conditions. Annals of the New York Academy of Sciences. 1959;83:463-79. 3. Barr L, Barrera A. Use of hair grafting in scar camouflage. Facial plastic surgery clinics of North America. 2011;19(3):559-68. 4. Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Archives of dermatology. 1984;120(4):449-56. 5. Ridgway EB, Pribaz JJ. The reconstruction of male hair-bearing facial regions. Plastic and reconstructive surgery. 2011;127(1):131-41.
S1748-6815(17)30021-9
DOI:
10.1016/j.bjps.2016.11.032
Reference:
PRAS 5209
To appear in:
Journal of Plastic, Reconstructive & Aesthetic Surgery
Received Date: 22 November 2016 Accepted Date: 22 November 2016
Please cite this article as: Murphy SM, Connor J, Collins MP, Follicles First, British Journal of Plastic Surgery (2017), doi: 10.1016/j.bjps.2016.11.032. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Follicles First
RI PT
Siún M Murphy (corresponding author) MB BAO BCh BA MRCS FRCS (Plast) Consultant Plastic Aesthetic and Reconstructive Surgeon Blackrock Clinic, Blackrock, Co Dublin, Ireland Hair Restoration Blackrock, Samson House, Blackrock, Co. Dublin, Ireland [email protected]
SC
J O Connor MB BCh BAO FRCS RCPS Glasg FRCS Edin FRCS Eng FRCSI Consultant General Surgeon Hair Restoration Blackrock, Samson House, Blackrock Co Dublin, Ireland
M AN U
Maurice P Collins
MB BCh, BAO DLO FRCSI FRCS FRCSEd
Consultant General Surgeon Hair Restoration Blackrock, Samson House, Blackrock Co Dublin, Ireland
TE D
Conflict of Interest Statement
The authors declare that there is no conflict of interest to declare.
EP
Financial declaration
AC C
The authors declare that there was no funding received for this research.
ACCEPTED MANUSCRIPT Zoom in for the bigger picture. Thinking of follicles first in reconstruction of hair bearing skin. SM Murphy, J O Connor, MP Collins Sir,
RI PT
We congratulate the authors on their recent publication, “Beard Reconstruction: a Surgical Algorithm” (1). This is a very challenging area within plastic and reconstructive surgery that impacts on a patients’ sense of sense of wellbeing and self-esteem as well as on their social interaction. Loss of hair bearing tissue in the head and neck can result from surgery, trauma including burns, tumour ulceration and infection as well as some destructive dermatological disorders.
M AN U
SC
Achieving optimal aesthetic results in these patients in a cosmetically sensitive area such as the face is a challenging area. The difficulty in reconstructing these facial subunits is evident in the multitude of complex reconstructive techniques utilized to resurface the facial defect in practices and in the resulting literature. Despite recent advances in microsurgical techniques and free tissue transfer, achieving long-term results remains a challenge, with the additional effect on the donor region and its added surgical challenges.
TE D
The authors correctly point out that only a few donor sites are available to reconstruct these facial hair bearing areas, but to our surprise do not mention or utilize the most abundant supply of follicle rich skin – the posterior scalp. Locoregional and pre-expanded flaps are used to great effect in this case series, and certainly the authors can be commended for this. The series however shows the following defects requiring hair-bearing reconstruction:
EP
Defect Moustache region (philtral, post cleft repair) Philtrum post BCC excision Buccomandibular region post acne scarring Burns to beard and moustache
Reconstruction Local flap Pre-expanded FC temporalis flap Pedicled temporal flap Pre expanded pedicled scalp flap
AC C
While the surgical results are excellent, the procedures are not without their (albeit temporary) disfigurement with pre-expansion or pedicles, and their associated potential co-morbidities. In our experience, all of these defects can be dealt with to excellent effect with the Follicular Unit Transplantation. This technique was first described by Hodara in the late nineteenth century, and then by Okuda in 1939 with a publication of five articles entitled “Clinical and experimental study of living hair transplantation” in the Japanese Journal of Dermatology in 1939, describing 200 cases of reconstruction in cicatricial and congenital alopecia. No serious interest was expressed in hair transplantation until Orentreich’s publication on its use in androgenic alopecia in 1959(2). has been described in the literature before(3). Hair can be successfully harvested under local anaesthetic under strip excision (FUT) or Follicular Unit Extraction (FUE). This follicular concept was first described in 1984 (4) as hair
ACCEPTED MANUSCRIPT transplantation techniques develop, has revolutionized the care of many patients to date requiring this type of reconstruction. A publication in 2011 by Pribaz et al (5)mentioned plug grafts in 1 of their series of 34 patients, and a strip graft in another patient. We believe that all of the patients in both these papers could have been treated with either FUT or FUE procedures, significantly reducing their operative time and morbidity.
RI PT
It is our opinion that all plastic and reconstructive surgeons should understand the basic concepts of follicular transplantation when approaching patients requiring reconstruction of a hair bearing area of the head and neck. Even when the unit does not provide this service, the practitioners should consider hair transplantation as part of the multidisciplinary approach to these patients.
M AN U
SC
Yours etc,
AC C
EP
TE D
References 1. Ninkovic M, Heidekrueger PI, Ehrl D, von Spiegel F, Broer PN. Beard reconstruction: A surgical algorithm. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2016;69(6):e111-8. 2. Orentreich N. Autografts in alopecias and other selected dermatological conditions. Annals of the New York Academy of Sciences. 1959;83:463-79. 3. Barr L, Barrera A. Use of hair grafting in scar camouflage. Facial plastic surgery clinics of North America. 2011;19(3):559-68. 4. Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Archives of dermatology. 1984;120(4):449-56. 5. Ridgway EB, Pribaz JJ. The reconstruction of male hair-bearing facial regions. Plastic and reconstructive surgery. 2011;127(1):131-41.