The Best Graft Storage Solutions in Hair TransplantationFri 4 Feb 2011
I read somewhere that most hair transplant clinics use normal saline while some use tissue holding solutions which contain buffers, nutrients, and antioxidants which have been shown to reduce storage and ischemia-reperfusion injury. My question is: Do all Coalition doctors use tissue holding solutions?
Two years ago I did an extensive research study comparing grafts stored in normal saline for half of the 16 study boxes and grafts stored in HypoThermosol solution with ATP added to it in the other half of the boxes. ATP is a chemical in our bodies that fights apoptosis (cell death) which occurs in the absence of oxygen. We planted grafts in the paired study boxes (one saline, and the other HypoThermosol/ATP) at the following time points: 2 hours, 4 hours, 6 hours, 8 hours, 24 hours, 48 hours, 72 hours, and 96 hours.
The findings from this research are basically that for under 8 hours they are similar from a statistical standpoint. This confirmed the results Dr. Bobby Limmer in Texas achieved 19 years ago in his landmark study extending to 48 hours. In our study, for 24 hours and thereafter, there was a huge difference in survival in favor of the HypoThermosol/ATP grafts doing much, much better in survival percentage. Besides the superiority in percentage of grafts that survived, there was also a qualitative difference between the grafts in saline and those in HypoThermosol at 24 hours and beyond. The hairs growing from the HypoThermosol/ATP boxes were much fuller in diameter while the ones in saline were thinner.
In our own practice we use Plasma-Lyte solution, which is very close in pH (acidity) to human plasma, to hold all of our grafts. It is certainly more expensive than saline, but not exorbitant. HypoThermosol (especially if ATP were added), on the other hand, is much, much more expensive and, if used routinely in hair transplants, would have a serious impact on the price patients would have to pay for surgical hair restoration. The evidence so far certainly does not support the routine use of such an expensive solution. Perhaps there might be the occasional patient in whom a large number of pluggy grafts are being extracted via follicular unit extraction (FUE) and recycled into the scalp. Such grafts may be more susceptible to cell death and benefit from this type of fancy solution. Dr. Jerry Cooley has also done recent research using HypoThermosol with ATP added, but I don’t think we can even sort out from our research what percentage of the benefit was due to the HypoThermosol versus the contribution from the added ATP.
The instances in which follicular unit grafts have to be placed days later are very rare. I have only had one such episode in 22 years, when around 10 years ago a 35 year old developed chest pain and sweating during the procedure right after we had harvested all of the donor hair and had made around 200 small recipient sites. We had him moved immediately by ambulance to the hospital, where he was cleared that night and sent out with a diagnosis of a virus and some hyperventilation. He called me that night and we agreed to meet the next day, at which time we inserted the grafts and finished the procedure. These grafts were out 24 hours and grew fairly well from visual observation. In truth, it’s virtually impossible to distinguish 70% growth from 95% growth. This was proven by Dr. Manny Marritt years ago and published in Dermatologic Surgery Journal.
So the bottom line is that the jury is still out on what the perfect solution is. We’ve been using Plasma-Lyte for around 4 years now for the theoretical reasons I noted above and I can’t say that I have noted any difference grossly from the hair growth we received all those years using saline.
Mike Beehner, M.D.