Optimising size and depth of punch grafts in autologous transplantation of vitiligo and piebaldism: a randomised controlled trial

Abstract

Background: To date, autologous punch grafting appears to be the easiest and least expensive surgical technique for stable vitiligo and piebaldism. Punch grafting is available worldwide, with no need for specialised instruments. However, no reliable data on efficacy and safety of different punch depths and punch sizes are available. Objective/methods: To compare the efficacy and safety of different punch depths and punch sizes in autologous punch grafting, a randomised controlled trial was performed in 33 patients with vitiligo or piebaldism. In each patient, four depigmented regions were allocated to: 1.5 mm deep grafts, 1.5 mm superficial grafts, 1.0 mm deep grafts, and 1.0 mm superficial grafts. Primary outcome was the total pigmented surface area. Secondary outcomes were Patients Global Assessment (PGA) and side effects. Results: Six months after grafting, 1.5 mm grafts showed a significantly larger pigmented surface area compared to 1.0-mm grafts (p < 0.001), though more side effects as well. No significant differences in the total pigmented surface between different punch depths were found. Deep grafts showed more erythema compared to superficial grafts. Conclusion: We recommend 1.5 mm superficial grafts in autologous punch grafting for trunk and proximal extremities in patients with stable vitiligo and piebaldism.

Skin seeding technique with 0.5‐mm micropunch grafting for vitiligo irrespective of the epidermal–dermal orientation: Animal and clinical studies

“…Furthermore, the occurrence of adverse events, including a cobblestone appearance, was less frequent with the SST than in the prior report, although our findings may be influenced by the small sample size in the present study and differences in the postoperative follow‐up periods between studies. This is consistent with previous studies, in which smaller punch grafting sizes yielded better results with a less frequent cobblestone appearance 15 …”

“…This is consistent with previous studies, in which smaller punch grafting sizes yielded better results with a less frequent cobblestone appearance. 15 In our preliminary animal study, we confirmed that punch grafts of all sizes (3, 2, 1, 0.8 and 0.5 mm) inserted in the dermal orientation were eventually well integrated into the surrounding tissue at 2 weeks postoperatively. In addition, human skin samples from the dermal orientation group showed that Figure 2.…”

Biology of human melanocyte development, Piebaldism, and Waardenburg syndrome

“…Management with cosmetic camouflage and hair dye can improve quality of life and provide significant emotional benefit . Tissue grafting and cell transplantation have high success rates for the depigmented patches of Piebaldism . The literature for depigmented patches associated with WS is anecdotal, but theoretically should be similar to Piebaldism.…”

Stable segmental vitiligo treated with punch mini‐grafts and narrow band UVB phototherapy

“…Keratinocyte cancer is endemic in Australia. 1 While rarely life-threatening, keratinocyte cancer can significantly impact quality of life (QOL), with defects and scars often appearing in aesthetically sensitive areas. 2 Mohs micrographic surgery ('Mohs') is considered as gold standard for certain skin cancers involving cosmetically or functionally important locations, with superior cure rates and QOL compared to conventional excision.…”

“…At present, there are only five studies that discuss the benefits of treatment with mini-grafts and NB-UVB phototherapy for vitiligo. 1,[4][5][6][7] The first patient was a 10-year-old female with vitiligo from 6 years of age with a history of bronchial asthma and hypothyroidism treated by levothyroxine. She had previously been treated with 270 sessions of NB-UVB phototherapy over a 3-year period, in addition to topical and systemic steroids (dexamethasone) without much improvement.…”