Scalp necrosis prevention in hair transplant is possible if accurate techniques are used and experienced and trained surgeons perform the surgery. It is very essential to identify it on time so that surgeons can make strategies to decrease its occurrence. Mortification (necrosis) is thought to happen when a dark or bluish color appears on the recipient area. This bluish color indicates that under the skin blood clotting or pooling will happen. This clotting will stop the fresh blood from reaching the skin which leads to insufficient oxygen delivery to the skin cells and ultimately cell death occurs. It is a very uncommon complication of hair restoration surgery. But this adverse complication has a great influence on the psychological and aesthetic outcomes of the patient. That’s why a surgeon must have a thorough understanding of this complication and also about its control measures and treatment. This complication is mostly developed in the central area of the head because it is that area of the head where vascularization is very less as compared to other areas but there are chances that this can happen on other areas of the head. It was reported that this complication mostly occurs when a large number of grafts from the recipient site are used and this intense breaking of the skin leads to decreased vascularization and ultimately cell death occurs. But unfortunately, there are very few studies present on the occurrence of this complication and its treatment.

Scalp necrosis prevention in hair transplant can happen only by authentic planning and proper execution of surgery. The method that is mostly used in the treatment of this complication is the use of topical nitroglycerine. It is said that it is the major constituent that is used in the treatment of mortification that is caused by dermal fillers. Nitroglycerine treats cell death by inducing dilation in blood veins and arteries and also by increasing perfusion in oxygen-deficient tissues. So, based on different research the use of nitroglycerine spray is recommended during restoration surgery to decrease the incidence of cell death. It was also reported that black or blue shades which are signs of cell death also fade after the insertion of nitroglycerine within 30 minutes in many reported cases. The nitroglycerine sprays are mostly used in areas that are more prone to cell death. Nitroglycerine is used in the form of ‘’spray’’ mostly because in this form it is more absorbable and also absorbs rapidly. After its use, it is washed out immediately to avoid any side effects. The side effects that are seen mostly in its use are headache, lathery, hypotension, decreased heartbeat, and small bleeding in the area where it is administered.

There are also many other techniques in scalp necrosis prevention in hair transplant and those are using the minoxidil drug before the surgery for few months, reduce the utilization of epinephrine, the patients who are at greater risk of cell death perform extraction of grafts in one day and harvesting of grafts on another day, perform harvesting and extraction of grafts in a form of horse-shoe shape are leaving the central part of the head-on first day of surgery if any kind of wounds are appearing on the harvested area stop the surgery and perform it on next day, utilize needles in the place of blades in the areas those are at high risk of cell death, and stop harvesting grafts in those areas where signs of mortification appear i.e. blue and black color.

Scalp necrosis prevention in hair transplant is thus done by using nitroglycerine or by following other appropriate strategies. The early and immediate use of nitroglycerine can prevent further long-term complications of deficient oxygen supply. Thus, the use of nitroglycerine is recommended in every restoration surgery because of its positive effects on blood flow that enhance the supply of blood and also induce vasodilation in veins, arteries, and capillaries. Hence, it is proved that timely and early diagnosis and immediate administration of nitroglycerine can reduce the incidence of mortification or cell death and also prevent long-term complications of ischemia.

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