Jerry Cooley: Graft Storage Solutions
Summary: Dr. Cooley has been experimenting with finding the best
hair graft storage solution. His talk addressed three critical
points, all of which would make a good title for the presentation:
1. Ischemia-reperfusion injury and free radicals in hair
2. Is chilled saline the best holding solution for grafts?
3. How can we make follicular unit grafting even better?
In hair transplantation our common goals are to find methods
to improve hair transplantation with naturalness and density.
Our goal should be 100% graft growth in 100% of patients
with no effluvium. The major factors affecting transplant
growth are: Transection, dehydration, crushing, vascular,
When a follicle is removed from the scalp it suffers from
ischemia, or a lack of oxygen. When the follicle is planted
back into the scalp it is reperfused, or exposed to high
levels of oxygen. The trauma to the follicle from a being
deprived of oxygen to reperfused with oxygen is called Ischemia-reperfusion
Injury or IRI.
Another concern with transplants is exposure to free radicals.
Free radicals are unstable, toxic molecules which can damage
tissues and cells. Free radicals are caused by diverse triggers
including Ischemia-Reperfusion Injury. Since it has been
shown that transplanted organs fail due to immune rejection
and IRI, could IRI affect the growth of hair grafts? Dr.
Cooley's set out to study if Ischemia-reperfusion injury
exists in transplanted hair follicles. His conclusions show
the answer is most likely yes.
Dr. Cooley described his materials and methods for testing
IRI in transplanted grafts versus control grafts.
The results of his study indicate that compared to control
samples, ALL transplanted (reperfused) samples showed elevated
MDA with the highest readings in the first 2 hours. Dr. Cooley
concluded the positive MDA assay suggests that IRI does occur
in hair transplants although more patient tests need to be
conducted for confirmation.
What is the best method to reduce IRI? Dr. Cooley feels
we should determine whether there is less MDA when using
existing techniques from tissue/organ transplantation, specifically
formulated to support tissues at low temperatures. If so,
we should also determine whether these techniques change
the clinical outcome of the patient's hair growth. We should
also determine the best graft storage solution. Is it saline,
cell/tissue culture media, or hypothermic tissue storage
media? What is the best temperature? Should the grafts be
left on the surface of the solution or fully immersed? To
ensure 100% growth in 100% of patients these questions need
to be fully researched.
Chilled saline is the most commonly used graft-holding solution
today, but is chilled saline really the best holding solution?
Dr. Cooley stated that saline lacks metabolic nutrients to
prevent apoptosis, buffers to control pH, and antioxidants
to prevent IRI. Dr Cooley concluded by describing three new
possible graft holding solutions including Moser Machte (wish)
Media, a solution being developed by Doctors Rose and Cole,
and his personal experience with cell culture and his personal
experience with cell culture and Hypothermosol from Biolife
By using new holding solutions we might be able to achieve
100% growth in 100% of patients with no effluvium. In a bold
statement, Dr. Cooley predicted in 5 years no hair transplant
surgeon will be using saline as a storage solution.
was a follow up discussion amongst the physicians on methods
to reduce IRI by using FIT/FUE techniques and
only removing hair follicular units once they were ready
to be placed. Some of the doctors suggested the moving a
hair follicle directly from the donor site to the recipient
site was the best technique to reduce IRI. In such a case
each hair follicle is only out of the body for 15 seconds
at most and is never placed into a holding solution.