Management of Early Scalp Ischemia and Necrosis After Hair Transplant: A Practical FLOW-Based Protocol (Case Report)

Abstract

Scalp ischemia and necrosis are rare but clinically significant complications following hair transplantation, with a reported incidence of 0.1–1%.¹,² These complications may lead to graft loss, delayed healing, and permanent scarring if not recognized early. Current management strategies are often summarized using mnemonic-based approaches such as LAW(N) (Lidocaine, Aspirin, Warm compress, Nitroglycerin), which lack a structured, cause-oriented framework.²,³

We present a case of early scalp ischemia successfully managed using a structured FLOW protocol, emphasizing Fixing the cause, Local vasodilation, Optimization of oxygenation, and Wound care. Early intervention resulted in complete recovery without progression to necrosis.

This case highlights the importance of early diagnosis and a systematic approach to management, providing a practical and reproducible strategy for clinicians.