VITILIGO SURGERY

What are Vitiligo surgery treatments?

The surgical procedure involves taking skin from areas with normal pigmentation and transplanting it onto depigmented skin. This surgery has shown effectiveness in 90%-95% of cases. The surgical techniques include:

• Tissue grafting
• Cellular grafting

Tissue grafting: Following techniques can be used:

• Punch grafting:This technique involves punching out grafts (1-2mm in diameter) from pigmented skin, known as donor sites, typically from areas like the thighs, buttocks, posterior ear, or upper arm. Then, sockets are created in the depigmented skin area, referred to as the recipient area, and the grafts are placed in these sockets. Post-surgery, dressings are applied to the treated sites. Typically, within 7-10 days, the grafts are integrated into the recipient skin. Subsequently, the patient undergoes phototherapy and topical steroid treatment to ensure an even spread of pigment.

Advantages:This method is cost-effective and efficient for all areas except for the corners of the mouth and nipples. It's also effective for challenging areas such as fingers, toes, palms, and soles, which can be difficult to treat using other techniques.

Disadvantages:This technique is not suitable if large areas are involved.

• Suction blister epidermal grafting:In this technique, very thin grafts (consisting of epidermis only) are harnessed from the donor area by applying a prolonged suction pressure which leads to a physiological split at dermo epidermal junction. These grafts are then applied on the recipient site after abrading it. The graft typically falls of within 7-10 days.

Advantages:Due to the thinness of the grafts, this technique yields outstanding cosmetic outcomes. The risk of scarring is minimal at both the donor and recipient sites.

Disadvantages:It is a time-consuming process as the grafts take time to separate, thus large areas can also not be treated.

• Split thickness grafting:This technique involves grafts consisting of the epidermis with a portion of the dermis. Local anesthesia is necessary for smaller areas, while larger areas may require general anesthesia. The split-thickness graft is then transplanted onto abraded skin at the recipient site and secured in place with pressure and immobilization.

Advantages: is a good technique to treat large areas in short span of time.

Disadvantages:This technique demands a high level of skill and expertise. There is a risk of scarring at the donor site, as well as the possibility of color mismatch and undesired pigmentary changes at the recipient site.

Cellular grafting: Following techniques are available:

• Non-cultured melanocyte grafting:This technique includes obtaining a biopsy sample from the recipient skin, which is then soaked in a trypsin solution to separate the epidermis from the dermis. Next, a cellular suspension of melanocytes is obtained and transplanted onto the abraded area of the recipient site.

Advantages:This method is suitable for treating fairly large areas.

Disadvantages:This method necessitates a high level of expertise and a well-equipped laboratory.

• Transplantation of cultured autologous melanocytes:This technique entails culturing melanocytes in vitro (outside the body, in a laboratory culture medium). The culture growth process typically takes 15-30 days, following which the isolated melanocytes in suspension are transplanted onto the abraded donor area.

Advantages:This method can address a wide range of body areas and is particularly beneficial when more than 30% of the body is affected. However, it is expensive and demands an extensive tissue culture laboratory setup.

• Autologous cultured epithelial grafts:This technique involves obtaining an epidermal sheet through cell culture, which takes several weeks to grow. Once grown, this epidermal sheet is placed onto a petrolatum gauze and applied to the recipient site, followed by dressing.

Advantages:Large areas of skin can be treated.

Disadvantages:Its expensive and requires skill and equipment.

Who are candidates of vitiligo surgery?

• In cases where patients have undergone medical and light therapy without achieving satisfactory results.
• For adult patients who have had stable vitiligo for at least one year (no new patches developing or existing patches not expanding).

Who are not so good candidates for surgery?

• Unstable disease
• Children
• Patients who forms scars and keloid easily or have such history.

What should I expect post -surgery?

• You may need to take time off and be absent from work for several days.
• Follow-up visits may be necessary to change dressings or assess the status of the graft, depending on the technique used.
• Continued phototherapy and medical therapy may be needed for 2-3 months to attain the best results.

What are the possible side effects of surgery?

• Infections.
• Graft colour mismatch.
• Graft rejection.
• Scarring at donor site
• Persistent vitiligo