If you take a man with Class VII you will see the limits of the donor area. The boundaries of this zone extend from in front of the ears, around the temples, and to the back of the head. The hair at the temples may recede back toward the ear, and the balding area of the crown may dip quite low into the occipital area, at the back of the head. Visible scarring may be revealed if the thinning advances, and donor tissue has been taken too high, too low, or too far in front of the ears.
Scarring in the Donor Zone
Another problem involving scarring in the donor area is that of the widened scar. In a patient without a systemic disease or drug use that retards healing, a well-closed, non-infected incision should eventually appear as a thin white line, well camouflaged by the hair, even possible now to be made almost invisible with the new closure methods being utilised. Sometimes, however, this is not the case; if the donor strip is taken too low in the back of the head (toward the top if the neck), a widened scar can result. Often, as men get older, the inferior hairline (at the neck) will move higher. If this is the case, a low, widened scar can be a cosmetic liability.
In addition, certain patients with an inborn weakness of collagen or defects in the building of new collagen (collagen is the connective tissue protein of which ligaments, tendons and scars are made) may develop wider than normal scars regardless of how well the incision is closed. Surgical wisdom has always taught us that closure of any wound under tension (such as a wide incision or in taut tissues) can lead to a widened scar. Therefore the donor strip should be made as narrow as possible, based on the tightness or laxity of the patient’s scalp.
This is a problem seen after multiple transplant procedures: a tight, unyielding, fibrotic donor area. This is why surgeons like patients with lax scalps. Occasionally, though, a paradox exists; when patients who have laxity heal with widened scars. It is possible that these patients may have suffer from a collagen defect. In short, careful evaluation and planning can result in fine, cosmetic scars in almost all cases;
When the outmoded harvesting techniques of punch grafting with open donor healing were used, the result was a "shotgun" or "moth-eaten" appearance that is cosmetically quite displeasing. This type of scarring also renders further strip harvesting difficult as it complicates the estimation of needed strip size for a given number of grafts. Similar problems arise when the patient’s donor area has been subjected to multiple small strip harvests, with a "stairstep" pattern of linear scars.
Strip harvesting as a technique is widly deemed the most expedient and efficient method of harvesting. If these techniques are properly utilised, then the fewest hairs will be damaged at the time of harvesting. Furthermore, the integrity of the donor area will be preserved, scarring will be minimized, and preservation of donor reserves will be maximized for possible use in the future. This is an integral part of the essential long term planning process.
