Abstract / Summary
To evaluate clinical outcomes of autologous follicular unit and scalp-derived grafting techniques in the treatment of chronic cutaneous wounds. A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE and Embase were searched through February 2026. Studies evaluating follicular unit grafts, split-thickness scalp grafts or hair follicle-derived biologic preparations for chronic wounds were included. The primary endpoint was the proportion of wounds achieving complete re-epithelialization during study follow-up. Secondary outcomes included overall closure rates, time to closure, wound area reduction and adverse events. Sixteen studies comprising 239 patients were included. Follicular unit grafts demonstrated high overall closure rates (84% across 80 wounds). Split-thickness scalp grafts achieved 100% complete healing across 54 wounds, with rapid healing times (24-35 days). Biologic follicular preparations showed variable efficacy, with closure rates ranging from 30% to 100% across 70 wounds. Comparative studies consistently demonstrated superior wound healing with hair follicle-containing grafts relative to inter-wound or between-patient controls. Adverse events were limited and mild. Hair follicle-based grafting may be a potential solution for chronic nonhealing wounds, particularly in recalcitrant wounds. However, heterogeneity in study design and outcome reporting highlights the need for standardized, high-quality trials.