Hair Transplantation and Infection
Abstract & Commentary
Synopsis: A man developed a life-threatening infection as a result of a hair transplant procedure.
Source: Hirsch BE, et al. Staphylococcus aureus sepsis complicating hair transplant. Infect Dis Clin Pract. 2001;10: 101-102.
A 44-year-old man received his first hair transplant in a New Jersey dermatologist’s office and subsequently experienced marked local swelling at the donor site. Prior to the second treatment, he was prescribed prednisone 10 mg t.i.d. for 3 days. There was considerable bleeding at the donor site and a hematoma developed which was aspirated but subsequently recurred. After the second evacuation, the donor site was reapproximated with heavy woven silk sutures.
Within a week, the patient developed a high fever, myalgia, and pleuritic chest pains. One day later he was seen in the emergency room in florid sepsis. His blood pressure was 95/50 mm Hg; oral temperature 39.0° C; pulse rate 137 beats per minute; and respirator rate 28 breaths per minute. He was confused and diaphoretic and the scalp incison site was raised and swollen with dried blood matted over the wound. The admitting physician described the patient as "about as sick as possible."
The patient was immediately admitted and was resuscitated in the intensive care unit. Empiric therapy with imipenem, vancomycin, and gentamicin was changed to nafcillin once blood cultures taken at admission yielded oxacillin susceptible Staphylococcus aureus. The scalp wound was debrided and a bleeding source ligated. Silk sutures were removed and the wound irrigated and left open with normal saline wet-to-dry dressing changes. S aureus with identical susceptibilities to the blood isolate was cultured from the scalp.
The patient recovered completely with a total of 37 days of antimicrobial therapy. While he did not lose any of his hair grafts, he was not planning on having any further transplant surgery.
Comment by Thomas G. Schleis, MS, RPh
As mentioned in the article, the incidence of infectious complications of such procedures is less than 0.1%. However, in this case the occurrence of such an infection was life threatening. Hirsch and colleagues expressed caution regarding the use of steroids to control swelling in such procedures, and added that the dermatologist did not control the bleeding properly. The nonabsorbable suture material then provided an excellent local medium for bacterial growth. Combined, the patient became a perfect candidate for a procedure-related infection.
Being follicle’ly-challenged myself, I have on occasion considered such a procedure. In the flashy ads you watch the hair from the back of the scalp miraculously fly towards the top of the head, take root, and result in the development of a full, healthy head of hair. Then I saw an actual procedure being performed on a medical channel and completely lost interest. In reality, it involves cutting out a patch of hair from the back of the head, stitching up the affected area, carefully separating out sections of the removed hair and tissue for transplantation, cutting out plugs from the bald part(s) of the scalp with a device that was similar to that used in chemistry to bore holes in corks, and inserting plugs of the prepared hair follicles and tissue into the scalp. Obviously, because the head and scalp is highly vascularized there is a fair amount of bleeding, even in the best of circumstances. Considering the number of plugs that are generally transplanted, it is surprising that the infection rate is as low as it is.
The lesson to be learned here is that if you are considering such a procedure, know that while the statistics are on your side it would be wise to have a good infectious diseases specialist at your side as well.
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