Prevention of impending scalp necrosis by topical nitroglycerine in hair transplant surgery

Background Recipient site necrosis is a rare but potentially devastating complication of hair restoration surgery. Appropriate case selection and procedure performed by expert surgical team are although mandatory but not enough to prevent such event, particularly in megasessions. Timely recognition of impending necrosis is very important to consider preventive measures. Aims We aim to evaluate the use of topical nitroglycerine in preventing the incidence of impending necrosis in hair restoration surgery. Methods A retrospective observational study was designed to determine the efficacy of nitroglycerine spray in consecutive cases of hair transplant troubled with dusky skin vulnerable to necrosis. 1580 cases that underwent hair transplant were enrolled and topical nitroglycerine was used in 88 patients vulnerable to necrosis. A management algorithm was also proposed from clinical observations and literature review to avoid vascular injury that may lead to necrosis. Results 83 cases (94.32%) were rescued by topical nitroglycerine and five developed necrosis eventually. Five cases who had considerable black hue and treated successfully with above treatment were reported in detail. Conclusion Our experience with the use of nitroglycerine spray on the cyanotic area aided in the prevention of impending necrosis due to its vasodilatory effects on arterioles.