First of all, we have to bring the Vitiligo patients a stable Vitiligo. A stable Vitiligo is a condition where the patient is not having new lesions or extension of existing lesion for the last 9 months.
After stabilising patient , dermato-surgery can be taken up.
The followings are the Surgical methods available :
1. Punch grafting
2. Split skin grafting
3. Blister skin grafting
4. Melanocyte culture & grafting
5. Mesh grafting
6. Flip top grafting
7. Role of platelet rich plasma
8. Exicision or repair
PUNCH GRAFTING
Donor Site
Harvesting of normal skin is usually done from thigh (preferably lateral site) or any part of the body. Punch must be as small as possibly as 1mm or 2mm. If large punches are used, there is high chance of cobble stone formation. If 0.9mm punch is used, no cobble stone formation will be there. In case of big punches like 2mm,3mm,4mm is to be used, 0.5mm large than recipient site, should be taken.
Recipient site
Grafts should be placed at a distance of 2 to 2.5mm apart. It should be covered up with guage with Vaseline followed by pad . It will be opened in 10-14 days.
Spreading from the graft to the adjacent vitiligenous lesion pad is expected to complete in 3-6 months.
Spreading is faster if narrow band UVB/PUVA is used
Spreading is faster by injecting Platelet rich plasma.
SPLIT SKIN GRAFTING
Donor site
Lateral aspect of thigh ,retro auricular region , back are the usual sites for taking normal skin . The graft can be taken by using the Razor blade with Artery forceps or Humby’s knife or Silver knife.
Recipient site
The Vitiligenous patch is dermabranded by using dermabrador /Scapel knife . Sufficient bleeding points should be there. So that we know that there is enough dermabrasion. The split skin graft is placed .It is covered up with guage with Vaseline . It is opened by 10-14 days. Antibiotic and analgesic coverage is mandatory.
BLISTER SKIN GRAFTING
It is used instead of split skin grafting. Donor sites are flexor of forearm, medial aspect of arm, thigh, glutese region.
Suction blister can be achieved by negative pressure to the donor site after injecting local anaesthesia.
The cups are connected to the Suction machine with non collapsible flexible polyvimyl chloride tubing.
The vacume pressure is set between 300 to 400mm of Hg.
As blisters start appearing they can be seen through the transparent cups.
Blistering time varies from one to three hours and is proportional to the cup diameter and also varies from person to person.
The cups are not removed until blisters of the desired size are formed.
If blisters does not appeare within specific time 1CC of normal saline with xylocain 2% xylocain is injected in the skin under the cup.
The roof of the blister is cleaned with spirit and cut with the help of corned scissors.
It is transplanted to the recipient site after dermabrassion. Dressing is done as split skin thickness grafting/ punch grafting.
MESH GRAFTING
The split skin graft taken is cut into tiny pieces and making a paste and put into dermabraded area .
FLIP TOP GRAFTING
Here the split skin grafts taken is put under the Vitiligenous skin.
MELANOCYTE CULTURE & GRAFTING
Here, harvested split skin is cut into multiple tiny pieces and put in the media.
Dermalife Ma Medium
1. Contain basal medium in a light protected 500ml bottle.
2. Dermalife Ma life factors kit
Dermalife Ma factor kit:
1. Rh insulin life factor 0.5ml
2. Ascorbic acic life factor 0.5ml
3. L- Glutamine life factor 15ml
4. Epinephrine life factor 0.5ml
5. Sti Mel B life factor 5ml
6. TM3 life factor 1ml
7. Calcium chloride life factor 840ml
8. Antimicrobial supplement:
Gentamicine & Anphoteracine B 0.5ml
The cultured melanocyte is placed in the dermabraded Vitiligenous patch.
Dr. Yumnam Lokendra Singh, MD
Asst. Prof. JNIMS.
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