**21. Necrosis**

with a high risk of developing keloids, due to ethnicity and age, or with a personal history of

The postoperative complication of arteriovenous fistula is a rare complication of punch-graft hair transplantation. This complication has been observed after large punch-graft hair trans-

A pulsatile subcutaneous mass with an associated thrill or bruit and symptoms including pain or headache is a common presentation. Angiography is required for complete diagnostic evaluation. Clinical findings usually resolve spontaneously within 6 months, but superficial vessels can be ligated if the surgeon is concerned about vessel rupture or cosmetic appearance [11–13].

Infections of the scalp are very rare because it is well vascularized. Serious infections occur in less than 1% of cases and are, usually, associated with poor hygiene, excessive crust formation, or preexisting medical risk factors. There are several measures to be followed for prevention and infection control after hair transplantation: clean and decontaminated operating room, use of sterilized material, donor area asepsis, use of disposable instruments, and

The cobblestoning occurs when follicular units are implanted into hole or slits that are too

Occasionally, very nervous patients faint or feel faint during the procedure, but this can be managed by simple measures such as lowering the head between the knees or laying the

Pigment alterations of the skin can appear after a hair transplant. The transplanted area should not be subjected to the sun for at least 1 month after hair transplant procedure. A hat

hypertrophic scarring, should be informed of the potential for abnormal scarring [9, 10].

plantation is done especially to the temporal region in the 1970s.

**16. Arteriovenous fistula**

290 Hair and Scalp Disorders

**17. Infections**

**19. Syncope**

antibiotic prophylaxis [14, 15].

**18. Cobblestone appearance**

patient in a prone position [16].

**20. Pigment alteration**

small or implanted at the incorrect depth.

(men) or a scarf (for women) is recommended.

Recipient area necrosis is a rare but dangerous complication that arises when an increased number of recipient grafts are utilized and de-vascularization of the scalp occurs as a result of dense splitting of the recipient skin that results in large wound areas.

Predisposing factors of skin necrosis: Recipient-site necrosis is a result of vascular compromise. Predisposing influences composed of patient's factors and technical factors are as follows:


The treatment of central recipient area necrosis focuses on wound debridement and the cultivation of a viable wound base. Extensive sharp debridement is not recommended, and limited sharp debridement of the hyperkeratotic edge of the wound will stimulate reepithelialization. The application of mupirocin ointment is recommended twice daily. Occasionally, for extensive areas of necrosis, scalp expansion may be required for repair. In the treatment of tissue necrosis, hair transplantation can be performed after recovering tissue necrosis [16].

Other less common postoperative complications include granulomatous reaction [17], pyogenic granuloma [18], epidermoid cysts or cysts, and Kaposi's varicelliform eruption [19].
