| INTRODUCTION Hair transplantation (HT) is promising for hair restoration in androgenetic alopecia. Complications arise because of technical errors, patients' physiology or compliance errors. Common complications include bleeding, edema, infections, folliculitis, scars, pigmentation and neuralgia. Rare complications are pyogenic granuloma, arteriovenous fistulas, herpes zoster, lichen planopilaris, post-traumatic neuroma. Scalp necrosis, rare life-threatening complication, can cause irreversible damage. CASE REPORT A 32-year-old male had multiple, areas of necrosis over frontal and left temporal area of scalp and mid forehead, since 21 days which had occurred 2 days after HT. He was started on oral and topical antibiotics but within two days he presented with ill-defined erythema and edema behind both retro auricular areas extending upto sides of neck with restricted movements. Single, oval well defined, ulcer 1 x 2 cm with sloping edge and yellowish slough, was seen on left retro auricular region. WBC was raised and HCV was positive. Local part USG showed enlarged lymph nodes on right Va level. CT showed an infective process with diffuse subgaleal scalp collection and subcutaneous collection seen from left masseteric region tracking inferiorly along left sternocleidomastoid. Diagnosis was necrotising soft tissue infection following HT. DISCUSSION AND CONCLUSION Scalp infections are rare because it is well vascularized. Serious infections occur in < 1%, associated with excessive crusting, or preexisting medical risk factors. Scalp necrosis presents with dusky discoloration, crusting and eschar which detaches, leaving scars. It is caused due to insufficient blood supply to recipient area. Multiple punch wounds, done in HT, causes skin barrier dysfunction, rendering scalp more susceptible to microbiological invasion. Surgical stress might suppress patient’s immune defense; therefore, dense packing following HT may increase susceptibility and promote receipt area infection, which may accelerate progression of necrosis. Preoperative prophylaxis, timely diagnosis, and immediate treatment reduce morbidity. |
