Graft viability is improved and postoperative shedding is reduced for hair transplantation using histidine-tryptophan-ketoglutarate plus adenosine triphosphate and deferoxamine (HTK-AD) graft retention solution, according to study findings published in Dermatological Surgery.
The researchers conducted a randomized, double-blind, prospective, controlled clinical trial between September 2020 and June 2021. A total of 240 patients aged 18 to 60 years were randomly assigned in a 1:1 ratio to either the HTK-AD solution or Ringer’s solution (RS) groups . All participants were diagnosed with congenital hirsutism or androgenetic alopecia without comorbid diabetes, heart disease, hypertension, or any dermatologic or psychiatric disorders. Hair transplantation was performed in a mega session and patients were followed up, with postoperative spherical photographs taken at 1, 3 and 9 months. Patients and outcome assessors were blinded to group assignments.
There were 118 participants in the HTK-AD group (19% female, 36% graft ≥3000, graft density, 45 grafts/cm2; implantation time for ≥3000, 3.5 hours) and 119 patients in the RS group (25% female, 34% graft ≥3000, graft density, 45 grafts/cm2; implantation time for ≥3000, 5.5 hours) who completed the 9-month follow-up and were included in the final analysis. There were no significant baseline differences between groups (Pi <.001).
Hair follicles harvested from the occipital scalp by follicular unit extraction (FUE) were placed in either HTK-AD or cold Ringer’s solution (RS) to then be implanted into the recipients. Graft morphology and apoptosis levels were assessed by live or dead staining and Masson’s trichrome staining. Participants initially reported postoperative hair loss, which was confirmed by a blinded dermatologist. In addition, pretransplant recipient zones were randomly marked in 5 regions, each region being 1 cm2. During follow-up, a blinded dermatologist measured the numbers of hair follicles in these 5 areas using dermoscopy.
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Therefore, the findings indicated that HTK-AD is a safe maintenance solution that can be used as a substitute for RS or saline for isolated hair graft protection.
Organized dense collagen construction and higher cell viability were maintained by the grafts in HTK-AD versus RS, which became soft and easily deformed after 4 h preservation, adversely affecting engraftment. The frequency of mega-session transplantation after hair loss surgery decreased from 95.00% in RS solution to 73.81% with HTK-AD (Pi <.05). With at least 3000 grafts transplanted, the maximum rejection rate of RS (90%) was reduced to HTK-AD (85%; Pi <.001) and delayed shedding onset from RS (14 days) to HTK-AD (21 days). Pi <.001). Hair regeneration started earlier and hair loss duration was shortened in HTK-AD vs RS (Pi <.05). Final graft survival rates of mega-session transplantation show no difference between groups (Pi =.112).
No participants reported dissatisfaction with surgery, but greater satisfaction with recovery and surgical outcomes was reported by those in the HTK-AD group versus those in the RS group. No participants in either group experienced overt infection, necrosis, or additional serious adverse events. Postoperative erythema or folliculitis affected some participants.
Study limitations include unpublished data on oxidative stress damage detected during hair graft maintenance.
“Histidine-tryptophan-ketoglutarate solution with adenosine triphosphate and deferoxamine is superior to RS for hair graft preservation because it improves graft viability and alleviates postoperative shedding,” the researchers conclude. “The findings therefore indicated that HTK-AD is a safe maintenance solution that can be used as a substitute for RS or saline solutions for isolated hair graft protection.”
