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Tissue grafts in vitiligo surgery - past, present, and future.

Khunger N, Kathuria SD, Ramesh V - Indian J Dermatol (2009)

Bottom Line: Various grafting methods have been described including tissue grafts and cellular grafts.Stability of the disease is the most important criterion to obtain a successful outcome.The technique and followup management of the tissue grafts has been described in detail in this review.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and STD, V.M. Medical College and Safdarjang Hospital, New Delhi, India. drniti@rediffmail.com

ABSTRACT
Vitiligo, characterized by depigmented macules is a common disorder with a high psychosocial impact, particularly in darker skins. Surgical methods become important in cases where medical therapy fails to cause repigmentation or in cases of segmental vitiligo where the response to surgery is excellent. The basic principle of surgical treatment is autologous grafting of viable melanocytes from pigmented donor skin to recipient vitiliginous areas. Various grafting methods have been described including tissue grafts and cellular grafts. Stability of the disease is the most important criterion to obtain a successful outcome. Counseling of the patient regarding the outcome is vital before surgery. The technique and followup management of the tissue grafts has been described in detail in this review.

No MeSH data available.


Related in: MedlinePlus

Cyanoacrylate adhesive applied to secure the graft
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Figure 0006: Cyanoacrylate adhesive applied to secure the graft

Mentions: The recipient area is anesthetized by using either a topical anesthetic cream applied under occlusion 2 to 3 hours before the procedure by the patient, or infiltration anesthesia using 1% lignocaine without adrenaline is administered. For larger areas, general anesthesia is usually required. Preoperative medication, diazepam, 10mg orally at night and 2 hours before the operation relieves anxiety and may be given in anxious patients. After surgical cleansing, the vitiliginous area is first marked with a surgical pen and abraded by dermabrasion with a diamond fraise attached to an electric high-speed dermabrader at 10,000 rpm till pinpoint bleeding is seen. The recipient site can also be prepared using a pulsed Erbium-YAG laser or ultrapulse CO2 laser. Kahn et al.,[11] reported no histological difference in skin graft adherence between the short pulsed CO2 laser and a dermabrader. The ultrapulse CO2 laser is preferred over the Er:YAG laser because it achieves better hemostasis and causes an epidermal - dermal split at a single pass.[36] Manual dermabrasion with a manual dermabrader may also be used by beginners or when there is lack of equipment. The graft is carefully placed over the denuded recipient site, taking utmost care to place the dermal surface facing down. Immobilization of the graft is most important and is achieved by using surgical adhesive, octyl-2-cyanoacrylate and pressure dressing [Figure 6]. The adhesive gives excellent results to secure the graft and also has antimicrobial properties against staphylococci, pseudomonas, and E. coli.[37] In a study of 50 patients of stable, recalcitrant vitiligo, treated with split thickness skin grafting of over 180 lesions, cyanoacrylate adhesive was effective in immobilizing the grafts especially over the mobile areas.[38] It is best applied in an interrupted manner at the edges of the graft to allow drainage of serous fluid and at the center over mobile areas such as eyelids. A nonadherent dressing is then applied.


Tissue grafts in vitiligo surgery - past, present, and future.

Khunger N, Kathuria SD, Ramesh V - Indian J Dermatol (2009)

Cyanoacrylate adhesive applied to secure the graft
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2807155&req=5

Figure 0006: Cyanoacrylate adhesive applied to secure the graft
Mentions: The recipient area is anesthetized by using either a topical anesthetic cream applied under occlusion 2 to 3 hours before the procedure by the patient, or infiltration anesthesia using 1% lignocaine without adrenaline is administered. For larger areas, general anesthesia is usually required. Preoperative medication, diazepam, 10mg orally at night and 2 hours before the operation relieves anxiety and may be given in anxious patients. After surgical cleansing, the vitiliginous area is first marked with a surgical pen and abraded by dermabrasion with a diamond fraise attached to an electric high-speed dermabrader at 10,000 rpm till pinpoint bleeding is seen. The recipient site can also be prepared using a pulsed Erbium-YAG laser or ultrapulse CO2 laser. Kahn et al.,[11] reported no histological difference in skin graft adherence between the short pulsed CO2 laser and a dermabrader. The ultrapulse CO2 laser is preferred over the Er:YAG laser because it achieves better hemostasis and causes an epidermal - dermal split at a single pass.[36] Manual dermabrasion with a manual dermabrader may also be used by beginners or when there is lack of equipment. The graft is carefully placed over the denuded recipient site, taking utmost care to place the dermal surface facing down. Immobilization of the graft is most important and is achieved by using surgical adhesive, octyl-2-cyanoacrylate and pressure dressing [Figure 6]. The adhesive gives excellent results to secure the graft and also has antimicrobial properties against staphylococci, pseudomonas, and E. coli.[37] In a study of 50 patients of stable, recalcitrant vitiligo, treated with split thickness skin grafting of over 180 lesions, cyanoacrylate adhesive was effective in immobilizing the grafts especially over the mobile areas.[38] It is best applied in an interrupted manner at the edges of the graft to allow drainage of serous fluid and at the center over mobile areas such as eyelids. A nonadherent dressing is then applied.

Bottom Line: Various grafting methods have been described including tissue grafts and cellular grafts.Stability of the disease is the most important criterion to obtain a successful outcome.The technique and followup management of the tissue grafts has been described in detail in this review.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and STD, V.M. Medical College and Safdarjang Hospital, New Delhi, India. drniti@rediffmail.com

ABSTRACT
Vitiligo, characterized by depigmented macules is a common disorder with a high psychosocial impact, particularly in darker skins. Surgical methods become important in cases where medical therapy fails to cause repigmentation or in cases of segmental vitiligo where the response to surgery is excellent. The basic principle of surgical treatment is autologous grafting of viable melanocytes from pigmented donor skin to recipient vitiliginous areas. Various grafting methods have been described including tissue grafts and cellular grafts. Stability of the disease is the most important criterion to obtain a successful outcome. Counseling of the patient regarding the outcome is vital before surgery. The technique and followup management of the tissue grafts has been described in detail in this review.

No MeSH data available.


Related in: MedlinePlus