Recipient Site Necrosis After Tumescent Infiltration with Adrenaline in Hair Transplantation.

Follicular unit extraction (FUE) is a recent and widely used surgical procedure for hair restoration (1,2). Complications are rarely reported in literature. Herein, we report the first case of recipient site necrosis. We used hyperbaric oxygen therapy (HBOT) as an adjunctive therapy in this patient in order to restrict necrosis area in length and depth and increase wound healing. A 33-year-old man, referred to our hyperbaric medicine department from a different private hospital due to a scalp necrosis after the hair transplantation surgery, which appeared on the first day after the operation. The plastic surgeon who performed the surgery provided us with the patient history. The patient had suffered hair loss localized to the frontal and vertex areas and was diagnosed with androgenic alopecia Norwood grade III. He underwent hair transplantation surgery with the FUE technique. The ring block was administered in the frontal and occipital scalp by using a 31-gauge needle, infiltrating 2% prilocaine hydrochloride with 1:100 000 adrenaline. After ring anesthesia, tumescent saline solution with adrenaline 1:100 000 (1 mL adrenaline / 100 mL saline) was then injected in the entire recipient site to make it turgid. Approximately 1800 grafts were harvested with a 1 mm punch and were transplanted to the frontal site. Three hours after the surgery, the patient suffered from a pain in the recipient site, and cyanosis was found on examination. The cutaneous lesion then rapidly evolved into a necrotic appearance (Figure 1, a).