Treatment of Stable and Recalcitrant Vitiligo by Autologous Miniature Punch Grafting: A Prospective Study of 1,000 Patients

Malakar, Subrata; Dhar, Sandipan

doi:10.1159/000018089

Cited by 89 publications

(108 citation statements)

References 8 publications

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“…In 10.57%, there was no spread of pigment, while in 2.39%, depigmentation of grafts was noticed. Polkadot appearance (43.98%) and color mismatch (34.32%) were the most frequent side effects [48].…”

Section: Minigrafting or Punch Graftingmentioning

confidence: 99%

Surgical management of vitiligo

Mulekar¹

2010

Expert Review of Dermatology

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Vitiligo is a common condition characterized by hypopigmented and/or depigmented spots on the skin, affecting approximately 1-2% of the world population. Until approximately 30 years ago, it was exclusively treated by medical therapies. The most commonly used medical therapies include topical steroids, calcineurin inhibitors and phototherapy. Lesions on the face and neck respond the best to medical therapies, followed by lesions on the proximal extremities and trunk, while those distributed over acral parts of extremities and nonhairy areas, such as the wrist, feet and male genitals, respond poorly. Surgical methods complement medical therapies by providing melanocytes to these refractory lesions, and are indicated for unilateral segmental and clinically stable bilateral vitiligo, refractory to medical treatment. Tissue-grafting methods include minigrafting or punch grafting, epidermal grafting and split thickness grafting. These methods use full-thickness punch grafts, roof of epidermal blisters and shave biopsy samples, respectively, as the source of melanocytes. Cellular grafting includes noncultured and cultured melanocytes/keratinocytes suspensions obtained from trypsinizing the shaved skin biopsy sample as a source of melanocytes. Recent advances over the years have enabled dermatologists to treat extensive areas located on any anatomic site in a single operative session by surgical intervention. The purpose of this review is to describe the selection criteria for the surgical treatment, their utility and limitations in the various types of vitiligo.

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Section: Minigrafting or Punch Graftingmentioning

confidence: 99%

Surgical management of vitiligo

Mulekar¹

2010

Expert Review of Dermatology

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“…The harvesting method used depends upon the chosen surgical technique. In case of the full-thickness grafts, punch biopsies are taken at a distance of 1–5 mm from each other under local anaesthesia [1, 14]. For the blister technique, bullae can be induced manually with liquid nitrogen (3–6 freeze-thaw cycles for 3–5 s [13]) or with appropriately sized cups of sterilized disposable syringes at a sustained suction pressure of approximately 300 mm Hg for 30 min to 3 h [15].…”

Section: Procedures For Harvesting Donor Skinmentioning

confidence: 99%

“…The grafts will be implanted into perforations previously made at the recipient site using a biopsy punch under local anaesthesia. The grafts should be placed 4–8 mm apart because apparently pigment cells seem not to migrate beyond 5 mm [1], although a spread even up to 10 mm after using grafts larger in diameter has been published [14]. This probably depends upon the individual skin type [18].…”

Section: Full-thickness Punch Graftsmentioning

confidence: 99%

“…All surgical techniques (table 1) have the same basic principle: to transplant autologous melanocytes from a pigmented donor skin to regions without melanocytes [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. Although this is theoretically possible in all patients with a pigmented donor area, some prerequisites are necessary for vitiligo patients to be eligible for transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Techniques for Vitiligo: A Review

Geel

Ongenae

Naeyaert³

2001

Dermatology

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Although the treatment of vitiligo has improved during the last decade, therapy is still not satisfying for many patients. This is probably due to the fact that the aetiopathogenesis is unknown. Several treatment modalities, such as PUVA, UVB and local corticosteroids are currently used in the treatment of active vitiligo. However, these treatments usually induce incomplete repigmentation. Surgical methods intended to repigment leucoderma are an interesting therapeutic option if patients have stable disease. Two types of surgical techniques are available: tissue grafts and cellular grafts, with in between autologous cultured epithelial grafts. Tissue grafts are full-thickness punch grafts, split-thickness grafts and suction blister grafts. With tissue grafts, only a limited surface area can be treated but with good results in the majority of cases. Cellular grafts include non-cultured keratinocytes/melanocytes and cultured melanocytes. The exact success rate of repigmentation with cellular grafts is still unknown, since only a small number of studies have been published. Starting from autologous cellular suspensions, epithelial grafts of various compositions can be cultured in vitro. They can be used for larger areas. The purpose of this review is to describe the applications of different surgical techniques used to treat recalcitrant vitiligo.

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“…However no sealing solu on was used in this study to secure the gra s as in Falabella's technique since simple pressure was enough to secure them. In a prospec ve study of 1000 pa ents of stable and recalcitrant vi ligo the results of miniature punch gra ing was evaluated by Malakar and Dhar 23 . In 656 (74.55%) pa ents, 90-100% repigmenta on was achieved, in 93 (10.57%) pa ents there was no spread of pigment, while in 21 (2.39%) depigmenta on of the gra was no ced.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Miniature Punch Grafting Followed by Puvasol Therapy in Refractory Stable Vitiligo

Gupta

Chaudhary

Goyal

et al. 2017

Nepal J Dermatol Venereol & Leprol

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Introduction: Vitiligo affects approximately 2% of the worldwide population regardless of race, ethnic background or gender. When the medical methods are not successful, surgical procedures may be considered with the aim of placing a new source of pigment cells to reinitiate melanogenesis within the affected areas. This study was conducted to evaluate the efficacy of combining punch grafting followed by PUVASOL therapy in vitiligo patients. After punch grafting patients are given PUVA/PUVASOL exposure.

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Treatment of Stable and Recalcitrant Vitiligo by Autologous Miniature Punch Grafting: A Prospective Study of 1,000 Patients

Cited by 89 publications

References 8 publications

Surgical management of vitiligo

Surgical management of vitiligo

Surgical Techniques for Vitiligo: A Review

Efficacy of Miniature Punch Grafting Followed by Puvasol Therapy in Refractory Stable Vitiligo

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