British
Journal
of Plastic
Surgery
(1977)~ 3% S-53
HAIR GROWTH AS A LATE SEQUELA GROIN
IN SKIN GRAFTS
FROM THE
By THOMASRAYVECCHIONE, M.D. Clinical Instructor of Surgery, Division of Plastic Surgery, University of California at San Diego California
FULL thickness skin from the inguinal region is often used in pre-pubertal patients The donor site is convenient, primary closure is possible and scars are slight. One disadvantage has come to light in the following case: hair growth at puberty. CASEREPORT A IT-year-old Caucasian boy was born with bilateral syndactyly between the long and ring fingers. At age 3 they were separated and skin grafted with full-thickness skin taken from the groins. At 13 the skin grafts became thicker and darker in colour. By 15, he began to note the growth of pubic hairs at the proximal portion of the skin grafts on both hands. He became very self-conscious especially when his peers called attention to the growth, the implications in this age group were most embarrassing to him (Fig. I). The patient was taken to the operating room and the grafts were de-epilated; some trimming
FIG. I.
Separated syndactyly lined with full-thickness groin skin when aged 3 years. Now at 17 years, terminal pubic type hairs are growing and the graft is thickened and wrinkled.
Address for reprints: Plastic and Aesthetic Surgical Centre, 306 Walnut Avenue, San Diego, California 92103, USA. 52
HAIR GROWTH
AS A LATE SEQUELA
IN SKIN
GRAFTS
53
FIG. 2.
The Id-year-old donor site extends well medial to the midinguinal point. The hair growth was found in the skin obtained from this region.
of excess graft and deepening of the web spaces were also performed. motorcycle repairman with good hand function.
The patient is now a
DISCUSSION
It is interesting through not surprising that groin skin retains its property as a target organ for the hormones of puberty after transplantation. In the child, the fine vellus hairs are short and groin skin seems almost hairless. Transformed into terminal hairs of the thick, short, curly pubic variety, they are a cosmetic handicap. The sebaceous glands in the groin are also stimulated to hypertrophy by the pubertal hormones and this, with the corresponding increase in blood supply, was most probably responsible for the thickening and slight overgrowth of the graft. The pattern of pubic hair growth is different in men and women. These were studied extensively by Dupertuis et al. (1945). The distribution of pubic hair in a sample of 3,858 fit men (age 18-45) was studied by McGregor (1961). Both studies show that the lateral distribution of hair in both male and female extends to the lower ends of the furrows marking the position of the inguinal ligaments. The thick growth of pubic hair thins out rapidly at the medial Q of the inguinal ligament. A significant amount of skin can be obtained in an area containing fewer hair follicles if one remains lateral to the midpoint of the inguinal ligament (Fig. 2). Certainly full-thickness skin grafts should not be taken from the medial third. Although hairs have little function in man they may have, particularly pubic hairs, profound psychological significance. REFERENCES DUPERTUIS, C. W., ATKINSON,W. B. and ELFTMAN, H. (1945). Sex differences in pubic hair distribution. &man Biology, 17, 137. MCGREGOR, D. (1961). Distribution of pubic hair in a sampIe of fit men. Brirish Journal of Dermatology, 73, 61.
Journal
of Plastic
Surgery
(1977)~ 3% S-53
HAIR GROWTH AS A LATE SEQUELA GROIN
IN SKIN GRAFTS
FROM THE
By THOMASRAYVECCHIONE, M.D. Clinical Instructor of Surgery, Division of Plastic Surgery, University of California at San Diego California
FULL thickness skin from the inguinal region is often used in pre-pubertal patients The donor site is convenient, primary closure is possible and scars are slight. One disadvantage has come to light in the following case: hair growth at puberty. CASEREPORT A IT-year-old Caucasian boy was born with bilateral syndactyly between the long and ring fingers. At age 3 they were separated and skin grafted with full-thickness skin taken from the groins. At 13 the skin grafts became thicker and darker in colour. By 15, he began to note the growth of pubic hairs at the proximal portion of the skin grafts on both hands. He became very self-conscious especially when his peers called attention to the growth, the implications in this age group were most embarrassing to him (Fig. I). The patient was taken to the operating room and the grafts were de-epilated; some trimming
FIG. I.
Separated syndactyly lined with full-thickness groin skin when aged 3 years. Now at 17 years, terminal pubic type hairs are growing and the graft is thickened and wrinkled.
Address for reprints: Plastic and Aesthetic Surgical Centre, 306 Walnut Avenue, San Diego, California 92103, USA. 52
HAIR GROWTH
AS A LATE SEQUELA
IN SKIN
GRAFTS
53
FIG. 2.
The Id-year-old donor site extends well medial to the midinguinal point. The hair growth was found in the skin obtained from this region.
of excess graft and deepening of the web spaces were also performed. motorcycle repairman with good hand function.
The patient is now a
DISCUSSION
It is interesting through not surprising that groin skin retains its property as a target organ for the hormones of puberty after transplantation. In the child, the fine vellus hairs are short and groin skin seems almost hairless. Transformed into terminal hairs of the thick, short, curly pubic variety, they are a cosmetic handicap. The sebaceous glands in the groin are also stimulated to hypertrophy by the pubertal hormones and this, with the corresponding increase in blood supply, was most probably responsible for the thickening and slight overgrowth of the graft. The pattern of pubic hair growth is different in men and women. These were studied extensively by Dupertuis et al. (1945). The distribution of pubic hair in a sample of 3,858 fit men (age 18-45) was studied by McGregor (1961). Both studies show that the lateral distribution of hair in both male and female extends to the lower ends of the furrows marking the position of the inguinal ligaments. The thick growth of pubic hair thins out rapidly at the medial Q of the inguinal ligament. A significant amount of skin can be obtained in an area containing fewer hair follicles if one remains lateral to the midpoint of the inguinal ligament (Fig. 2). Certainly full-thickness skin grafts should not be taken from the medial third. Although hairs have little function in man they may have, particularly pubic hairs, profound psychological significance. REFERENCES DUPERTUIS, C. W., ATKINSON,W. B. and ELFTMAN, H. (1945). Sex differences in pubic hair distribution. &man Biology, 17, 137. MCGREGOR, D. (1961). Distribution of pubic hair in a sampIe of fit men. Brirish Journal of Dermatology, 73, 61.
