| A proposito dell'argomento "esiti cicatriziali", vi riporto il risultato di una mia piccola ricerchina.
Comincio riportandovi l'intervento di patrick in riferimento alla mia domanda sul forum di forhair, nella quale chiedeve di descrivere le tecniche per minimizzare il rischio di formazione dei wihte dots, i puntini ipopigmentati che possono formarsi a seguito di un intervento FUE. Questa la risposta:
It is impossible to predict that (ndr - chiedevo se era possibile predire la formazione dei dots).We just noticed that patient with dark skin tend to have that side effect more often than fair skin.We tried to take precautions in every patients assuming they are at risk.
Here is some of the solutions and the radical behind it:
1 . COMPRESSION
When you have a 1mm punch ,it will produce a scarring of 1mm of diameter that could appear as white dot because scar tissue lack color.
In repair cases for plugs ,we use bigger punches and we sow with regular sutures the wound for 4 days;and we had no visible scarring because we reduced the size of the wound .We applied the same idea for the the donor area.If we reduced the size of the wound created by the punches ,we should end with no scarring at all.The question is how to do that because the area could be big.We used sutures ,staples,traction of the donor area ,compressive bandage,...Some of this technique could increase the discomfort and we tried to work with the patient to see what could be better for him.
2. TOPICAL STEROID
Scarring is a natural process of wound healing.It is the result of the inflammatory event that occur when there is a open cut of the skin.The steroid is an anti inflammatory and will decrease the scarring formation ;and also steroid is the treatment to flatten the hypertrophic scar .These medication act by "eating" the fibrose or scar tissue.
Same idea is applied for hair cycle products.
3 FARMING
It is the insertion of body hairs in the donor open sites.One of the treatment of scar or old plug scars is to graft them with hairs.It alleviate the contrast of the scar and the surrounding area and some times gives back some color to the scar.This procedure is also used to treat vitiligo which is a type of skin discoloration .Body hairs is proven grows also in scar tissue.In order to wait and see if there is white dots so we can treat them by grafting them,we just anticipate and graft the open sites.It is a preventive treatment.
Those are different avenue we have to minimize side effects of FIT in the donor area.And we are still looking for best way to address that matter.
Qui il post intero: http://www.forhair.com/hairtransplant/view...topic.php?t=648
Quindi, di fatto si puo agire in tre modi: comprimere la zona per ridurre lo "spazio vuoto", utilizzo di steroidi topici (che dovrebbero disinfiammare la zona e prevenire processi infiammatori) e inserimento dei BH nei fori di estrazione.
A proposito della procedura del FARMING, che prevede, appunto, l'iserimento di BH, c'è una procedura simile del dottore indiano, Arwind Poswal, che prevede di rimettere solo una pezzetto del capello estratto nel foro di estrazione. La procedura si chiama Donor sealing. Qui trovate informazioni su come funziona
http://www.fusehair.com//Donor%20seling.htm
Vi riporto un pezzetto:
Donor sealing
Wound healing in the donor area following extraction of the hair follicular
units is a complex event, where the doctor can intervene in various
ways
The issues at hand are---
1. Whether to leave the wound to heal by secondary intention?
2. If one tries to bring about a semblance of healing by primary in-
tention, then how to go about it?
The 2 relevant major events in healing of this type of wound are----
a) Collagen synthesis / fibrosis
b) Epidermization.
If the wound is left to heal by itself , (i.e. by secondary intention),
the process to collagen synthesis / fibrosis tips the balance against epide-
rmization.
As a result, one gets a cylindrical defect filled predominantly with collagen.
This results in appearance of white dot like scars (0.75mm to 1.25mm dep-
ending on the size of the punch used)
Attempt should, therefore, be made to have as close a resemblance to hea-
ling with primary intention as possible .
One option would be to close the individual punch holes (by sutures/adhesive)
Not only is this approach impractical, it also will lead to a lot of stretch on the surrounding skin.
The option we chose was to use the epidermis of the follicular unit to close the micro-punch hole.
In this method, the deeper layers of the wound heal by secondary intention/ collagen tissue, but the superficial layers, viz., epidermis heals by primary intention.
This method, therefore, tips the balance in favor of epidermization without excessive graft handling.
Epidermis is the color bearing layer of skin .When the wound heals with epider-mis on top, there are almost no pigment variations (excepting those that may
occur in nature).
Since the method involves sealing the donor wound with the epidermis, we have named it in a descriptive and self explanatory manner as “Donor Sealing”.
This approach solves some other problems too.
One of them being, that if one transplants the graft without removing/ trimming
the epidermis , there are chances of unevenness/cobblestoning in the recipient area.
This would happen more so if the grafts were to be placed in slits/ needle points.
The contributing factor being the extra epidermis in the same area.
By removing the epidermis from the graft, we get the tissue to be used to effect-
tively seal the donor wound.
At the same time, we get rid of the extra epidermis (which would otherwise be a liability in the recipient area).
In riferimento a questa procedura, l'opinione di Cole è la seguente:
http://www.forhair.com/hairtransplant/view...topic.php?t=630
" I am not a huge fan of donor sealing. donor sealing is simply taking the top section off a graft and putting it back in the donor extraction site. This is just bald skin. It will not typically grow hair unless there is a resting telogen hair high in the dermis that is relocated back to the donor area. Mostly it is simply the top of a graft with hair fragments an no viable hairs. We tried the same thing 3 years ago, well before Dr. A even began doing FUE. we were not impressed with the results.
Placing bald skin plugs back into the donor holes will not prevent any of the potential complications of FUE and it might actually be deleterious. By placing the plug of bald skin back into the extraction site, you limit the ability of the donor extraction site to contract. The space occupying bald skin exerts an outside pressure on the contracting skin that could make the extraction site more visible.
we are well versed in using plugs of skin from our long history in the hair surgery field. Plugs of many sizes have been used for years. Skin grafts of many sizes have been used too. Typcially, we saw that the plug of skin placed into a extracted hole lost its pigment or it became hyperpigmented 15 years ago. Skin grafts do the same thing and this is essentially what the donor sealing is- a skin graft. The primary method of grafting 15 years ago was to cut holes in the top of the scalp and place plugs ranging from 1mm to 5 mm in size. The resulting skin graft was typically lighter or darker than the surrounding area. therefore, donor sealing is nothing new and it offers no advantages. We prefer to allow the extraxction sites to contract and to treat them with anti-inflamatory agents to reduce the risk of hypopigmented spotting or to place body hair grafts into the extraction sites. This offers far better advantages than donor sealing in our opinion. We've tried both and we find our techiniques superior. of course we are open to Dr. A performing a study to test all methods if he likes and then to present his data in a scientific forum. We've evaluated all methods on our own and we have presented our efforts at medical meetings to a large group of physicians. This is what Dr. A should do in my opinion, as oppossed to simply marketing a technique that he claims to have invented even though its a technique that's been around in one form or another for over 40 years. he should also consider showing the results of this effort one year later rather than before the fragments of dead hair fall out. these dead hairs are not going to grow. if they stay in too long they might even create a foriegn body infamatory auto-immune reaction that can lead to a pseudocyst formation. "
Quindi secondo lui non è una soluzione valida e preferisce (come ha scritto patrick) utilizzare antifiammatrori o bodyhairs nel foro di estrazione.
In riferimento a Woods, non ho trovato interventi relativi ai white dots, ma gli ho scritto (oltre che per altro) chiedendo anche in riferimento a questo. Appena ho qualche nuova info la piazzo qua sotto. in ogni caso, in una sua intervista postata qui da Lorenzo sul vecchio form), gli viene chiesto cosa ne pensa degli interventi e delle sostanze da utilizzare in donor per favorire la guarigione. Lui molto sagacemente dice che la sostanza migliore resta il sangue del paziente.. 
E sull'utilizzo dei BH nei fori dei trapianti dice che se non si rovina la donor, questo procedimento non è necessario.
ciao
Edited by -cripto- - 1/12/2005, 13:46 |
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