Original article
Hair follicle–containing punch grafts accelerate chronic ulcer healing: A randomized controlled trial

https://doi.org/10.1016/j.jaad.2016.02.1161Get rights and content

Background

A prominent role of hair follicle–derived cells in epidermal wound closure is now well established but clinical translation of basic research findings is scarce. Although skin punch grafts have been used as a therapeutic intervention to improve healing of chronic leg ulcers, they are normally harvested from nonhairy areas, thus not taking advantage of the reported role of the hair follicle as a wound-healing promoter.

Objective

We sought to substantiate the role of hair follicles in venous leg ulcer healing by transplanting hair follicle–containing versus nonhairy punch grafts.

Methods

This was a randomized controlled trial with intraindividual comparison of hair follicle scalp grafts and nonhairy skin grafts transplanted in parallel into 2 halves of the same ulcer.

Results

Ulcer healing measured as the average percentage reduction 18 weeks postintervention was significantly increased (P = .002) in the hair follicle group with a 75.15% (SD 23.03) ulcer area reduction compared with 33.07% (SD 46.17) in the control group (nonhairy grafts).

Limitations

Sample size was small (n = 12).

Conclusion

Autologous transplantation of terminal hair follicles by scalp punch grafts induces better healing than punch grafts harvested from nonhairy areas. Hair punch grafting is a minimally invasive surgical procedure that appears to be effective as a therapeutic tool for chronic venous leg ulcers.

Section snippets

Study design

This study was designed as an open, single-center, randomized controlled trial with intraindividual comparison. Each patient had 1 leg ulcer that was divided into 2 halves of as similar a size as possible. To avoid bias ulcers were divided vertically in 2 halves because the venous return flows upwards from bottom to top. The 2 halves were randomized for each wound into an experimental and control area by a methodologist blinded to study data (Fig 1). The random allocation sequence was concealed

Results

Patients had a mean age of 73 years; 33.3% were men and 66.7% were women. Average initial ulcer size was 23.34 cm2. Average initial size for the experimental group was 11.35 cm2 and 11.99 cm2 for the control group. Average duration of the ulcers before surgery was 6 years.

Discussion

This study demonstrates that the half of the ulcer transplanted with scalp punch grafts experienced a statistically significant better outcome than the half transplanted with nonhairy grafts.

The fact that follicle-rich scalp punches improve wound healing reflects the clinical translation of the latest discoveries in hair follicle biology related to wound healing.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Considering that the hair follicle is a well-known reservoir of several types of stem cell,1, 4, 31,

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    Partially funded by grants from the Hospital General Universitario de Albacete.

    Conflicts of interest: None declared.

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    © 2016 by the American Academy of Dermatology, Inc.