Domeniul refacerii parului este o specialitate dinamica unde tehnologiile avansate permit chirurgilor sa obtina rezultate mai placute estetic. Pierderea parului pare sa dea batai de cap umanitatii inca de la evidentele inceputurilor istoriei in baza unei prescricptii medicale pentru refacerea parului care a fost inclusa in anul 1500 I.H. in Ebers papyrus of ancient Egypt.
Succesul transplantului de par modern depinde de fenomenul descris prima data de catre Orentreich in 1957, numit ”dominanta donatoare”. Parul preluat din fasiile cu permanenta creare a parului ale pacientilor cu alopecia androgenetica (zona donatoare) si transferate catre zonele scalpului care nu mai dau nastere firelor de par (zona destinatara), va continua sa creasca in noua zona atat timp cat zona de unde au fost recoltate va avea par.
Baromia transplanteaza zone paroase la animale;
J. Dieffenbach realizeaza auto-transplant de par in piele;
Okuda realizeaza insertii de grafturi pentru refacerea alopeciei;
Tamura implanteaza grafturi singulare prin injectare pentru refacerea pielii deasupra muntelui Venus la femei;
Limmer foloseste microscopul pentru crearea de 1-5 mici grafturi pentru a le insera in intepatura acului in piele
Uebel realizeaza extragerea unei zone donatoare liniare;
Unger limiteaza zona donatoare de recoltare prin delimitarea zonei de siguranta a zonei donatoare;
Woods recolteaza unitati foliculare singulare utilizand intepaturi circulare mai mici (1mm) cu o aparitie estetica acceptabila si o rata scazuta a sectiunii transversale;
Bernstein si Rassman descriu tehnica lor de transplant a unitatilor foliculare, publicand termenul ”unitate foliculara” in nomenclatura;
Rassman si Bernstein descriu tehnica FUT ca o tehnica chirurgicala in literatura medicala.
Parul variaza intre diferite grupari etnice si indivizi singulari. Acesta are doua structuri distincte: foliculul din piele si firul de par, care este vizibil la suprafata corpului. Sunt diferite tipuri de par.
Majoritatea firelor de par ”rasar” din scalp ca o grupare cu 4 fire de par. Gruparile sunt portiunile superficial vizibile a unitatilor foliculare (FU). Unitatile foliculare consta, in general, in 1 sau 4 foliculi de par si un folicul vellus.
Directia parului difera in functie de zona scalpului. Atat directia cat si unghiul inciziei trebuie sa fie deci individualizat in functie de zona scalpului.
Foliculul de par este un organ dinamic. Activitatea ciclica necesita regeneare si o noua asamblare a portiunii nepermanenta a foliculului de par in timpul fiecarui ciclu. In medie, valoarea de noi formatiuni de par se potriveste cu totalul de par cazut, mentinand astfel o acoperire consistenta.
Exista trei faze principale ale ciclului folicului de par: cresterea activa (anageneza); regresiva (catageneza) si pasiva (telogeneza). Fiecare faza in parte depinde in functie de tipul foliculului de par si de locatia geografica. Recent, cele doua stagii ale ciclului de par au fost descrise ca: eliberarea (exogen) si timpul de intarziere (kenogen).
Bolile care cauzeaza pierderea parului sunt clasificate in functie tipul de pierdere al parului, daca este difuz sau localizat si daca foliculul ramane intact sau este distrus si inlocuit de o cicatrice. Potentialii factori declansatori sunt atribuiti inflamatiilor, geneticii, mediului si hormonilor.
Tulburarile pierderilor de par au trei mecanisme esentiale care includ densitatea foliculilor, marimea foliculilor de par si durata ciclului cresterii parului.
Paradoxal, androgenii au efecte diferite asupra foliculilor de par umani in functie de suprafata corpului. Testosteronul este androgenul majoritar circulant la barbati. Testosteronul redus la dihidrotestosteron (DHT) de catre o enzima 5a-reductanta. DHT se leaga de receptorul androgen. In zona de calvitie a scalpului, enzima 5a-reductanta este in crestere, rezultand cresterea prudctiei de DHT.
AGA este cea mai comuna cauza a pierderii parului. Afecteaza pana la 70% din populatia masculina la mijlocul varstei adulte. MPHL se intampla in prezenta androgenilor la personale sensibile genetic. Nivelul crescut recent de prostaglandina D2 in foliculii de par este sugerat ca fiind o cauza majora a AGA.
Cheia carcateristica in MPJL este miniaturizarea foliculara. Durata fazei cresterii active se reduce de la 2-6 ani la cateva luni, in timp ce faza de repaus se prelungeste relativ. Noua generatie de par devine mai scurta, mai fina si mai deschisa la culoare si ascunde scalpul mai putin. Tranzitia poate fi graduala sau poate veni in valuri si bineinteles amploarea MPHL este imprevizibila.
Modelul masculin incepe, in general cu o recesiune bitemporala, urmata de calvitia vertexului si pierderea parului in mijlocul frontal, permitand terminalulului foliculului de par sa fie retinut in zona occipitala a scalpului. Sistemul cel mai frecvent utilizat pentru gradarea MPHL este Scala Hamilton-Norwood.
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