Poswal A. Donor sealing: A novel method in hair transplant surgery. Indian J Dermatol 2006;51:55-56.

Dr. Arvind's Donor Sealing Technique Validated
in the Indian Journal of Dermatology

Background
 
Donor sealing is the method employed to decrease visible scarring following full thickness punch excision of the skin in follicular unit extraction in hair transplant surgery. In hair transplant surgery, various methods are used for extracting intact individual follicular units from the scalp. Most of these techniques involve the use of punches of diameters ranging from 0.75 mm to 1.25 mm. Following the extraction of the follicular units the donor area wounds are left to heal by secondary intention. Healing by secondary intention leads to formation of scar tissue at the donor site, which is visible as white dots.

The technique of donor sealing involves the use of the epidermis of the follicular unit grafts to close the donor area wounds to: a) avoid visible 'white dots', b) hasten the healing process.

In cases where donor sealing was done the wound appears to heal by primary intention since the epidermis is in close proximity to the surrounding epidermis. With well-approximated wounds, a continuous layer of epidermis forms within 48 hours.[1] The epidermis on contact with the epidermis of the surrounding skin heals by primary intention, while the lower part of the skin, i.e. the dermis heals by secondary intention; however that part which heals by secondary intention is not visible. The sealing material is analogous to the split thickness skin grafts used in skin grafting surgery.[2]

It was observed that the size of the punch does not alter the outcome as far as visible scarring is concerned since even with the use of smaller size punches of 0.7 mm, small hypo pigmented areas still occurred in cases where donor sealing was not done.

Donor sealing is, therefore, an effective way to reduce/minimize visible scarring following follicular unit extraction

Technique
 
The donor areas were shaved and cleaned with all aseptic aseptic precautions. The donor area was then infiltrated with local anesthesia (2% lignocaine with 1:100000-adrenaline preparation diluted in equal parts with Ringer's Lactate solution). The hair follicular units were then extractes using punches with diameter ranging from 0.75 mmm to 1.1 mm.

The hair grafts were extracted and kept in Ringer's Lactate solution. The upper part of the hair graft viz: epidermis was horizontally cut. The process was done under 2.5X magnification. The epidermis thus obtained is referred to as the sealant material. Taking all aseptic precautions (after the hair follicular units were transplanted into the recipient sites) the sealant material was placed in the donor extraction sites. Care was taken to keep the sealant epidermis flush with the level of the surrounding epidermis. The area was then bandaged for 24 hours. At the end of 24 hours, the bandage was removed. The patients were advised to daily wash the area with lukewarm water and mild soap solution. They were advised not to do any vigorous physical activity and not to rub the donor areas for 10 days. The patients were followed up on a regular basis at 10 days, 20 days, 3 months and 6 months postoperatively.

The postoperative outcome was recorded, viz: the degree of postoperative visible scarring and hypo pigmentation at the donor sites.

References
 
1. Marchesi, VT. Inflammation and healing anderson's pathology, 8th ed, 1985
2. Johnson TM, Ratner D. Skin graftis. In Ratz JL ed.: Text book of Dermatological surgey, 1992

Photo Illustrations

illustration of FUE donor scarring

FUE graft extraction

FUE graft immediately after extraction
 

FUE grafts before extracting the donor sealant
 

The donor sealant (epidermis) separated from the graft
 

Donor sealant being applied to the donor sites
 

For a more in-depth discussion about donor sealing among doctors and forum members,
please go to

Picture of donor sealing protocol, step by step
Donor Selaing, an in-depth discussion

To contact Dr. Arvind Poswal, please visit www.fusehair.com
Questions, please email hairsite@aol.com