The use of micrografts and minigrafts for the treatment of burn alopecia

The treatment of burn alopecia is a very challenging problem. Several techniques have been described in the past, mainly punch grafts, local scalp flaps, free scalp flaps, and tissue expansion. The fibrotic scar tissue that normally results after burn injuries has a precarious blood supply and is not an optimal ground for any type of graft. Single and double hair grafts (micrografts), and grafts with three to four hairs (minigrafts), because of their small size, have less metabolic requirements and are able to survive and grow healthy hair, even under adverse circumstances. Having seen these small grafts survive in scarred scalps from previous surgical procedures while treating patients with male pattern baldness, I believed it would be worthwhile to try them in cases of burn alopecia. The procedure is performed under mild intravenous sedation and local anesthesia in our operating room suite. Two cases are presented to illustrate the results that can be obtained with micrografts and minigrafts in a single session. They confirm that these small grafts survive, even over third-degree burn areas that have been split- thickness skin grafted, and that the grafts are safe and provide a natural result.