Randomized control trial to study the efficacy and safety of platelet-rich plasma as intraoperative holding solution in hair restoration surgery: A pilot study.

Background: Hair restoration surgery is a definitive surgical procedure undertaken for androgenetic alopecia (AGA). Platelet-rich plasma (PRP) therapy has gained importance in recent times as a valuable adjunct to therapy in hair restoration. However, the various beneficial effects of PRP as intraoperative holding solution hair restoration surgery remain to be objectively defined. Methods: Twenty cases of AGA were allocated into two groups (PRP and non-PRP). The follicular grafts harvested were stored in platelet-rich plasma/chilled ringers lactate solution depending on subject/control and were implanted in receding hairline using hair implanters. Patients were reviewed at the end of 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months using clinical and folliculoscopic images. The analysis was performed using SPSS version 20.0. Results: Follicular growth as assessed using the percentage of grafts in actively growing phase posttransplant showed faster recovery from 'shock effluvium' in the PRP group when compared with the non-PRP group from Week 4, through Week 8 and 3 months with the 'lead' increases of percentage growth difference being statistically significant(P = 0.02) between the two groups. At the end of 6 months, 100% of patients recorded a hair shaft length of >10 mm in the PRP group, whereas only 20% achieved >10 mm length. The difference in hair densities between PRP and the non-PRP group from 4 weeks up to 6 months in the non PRP group remained significant (P < 0.05). Conclusion: Intraoperative PRP as a holding solution improves outcome in hair restoration surgery by a significant improvement in the mean density of the implanted follicular unit grafts at 6 months.

A rare case of syphilitic Charcot joint involving left elbow.

Charcot arthropathy is characterized by joint dislocations, pathologic fractures, and debilitating deformities. Syphilis was believed to be the most common cause of Charcot arthropathy a century back, but now, it is one of the rare causes which get missed in the routine evaluation. We present a rare case of syphilitic Charcot joint in a middle aged, paraplegic, wheel-chaired bound male, who presented with a history of recurrent painless joint swelling. He underwent multiple surgeries on the left elbow to deal with his soft tissues and bony infections along with multiple courses of systemic high end antibiotics including anti-tubercular drugs without much benefit. He was even planned for midarm amputation. Timely opinion of dermatologist and correct interpretation of serological tests clinched the diagnosis. This case highlights a high index of suspicion and correct interpretation of serological test of syphilis is essential to diagnose tertiary syphilis. Timely management with injection benzathine penicllin resulted in life time gratifying outcome.