Split Skin Grafting Versus Miniature Punch Grafting in Vitiligo

Vanathi, T (2012) Split Skin Grafting Versus Miniature Punch Grafting in Vitiligo. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : The main intention of the any vitiligo surgery is to repigment the vitiligenous areas with a natural colour of the individual by various means: Simulating the natural colour by tattooing1, a method in which artificial pigments are introduced by microneedling technique. Using a thin Theirsch's2 graft to cover the denuded achromic areas. Various grafts, e.g. ultra-thin grafts3, suction blister4 and miniature punch grafts5, non-cultured epidermal cell suspension or transplantation, and epidermal6 and melanocyte cultures7 can be used to repopulate the decreased melanocytes. The lesional melanocytes can be stimulated from the periphery and the black hair follicles to proliferate, migrate and re-pigment the lesion by Therapeutic wounding8 e.g. therapeutic dermabrasion, laser ablation, cryosurgery (liquid nitrogen spraying), needling, and local application of phenol or trichloroacetic acid. AIM AND OBJECTIVES : 1. To compare the effect of split skin grafting versus miniature punch grafting in vitiligo patients. 2. To look for the adverse effects during these procedures. MATERIALS AND METHODS : Study Design : Type of study: Non randomized prospective comparative study Study Population : Sample Size: 50 patients divided into 2 groups Study period : July 2010- October 2011 (15 months) First 6 months: Interventional period Next 9 months: Follow-up period Study analysis: Results analysis- chi square test using spsf software. Place of study: Department of Dermatology, Government Stanley Medical College & Hospital, Chennai. From almost 400 vitiligo patients attending our OP (both old and new patients), 50 patients were selected according to the inclusion and exclusion criteria. They were enquired about the duration of their problem, any new lesions in the recent past or any new lesions occurring at the sites of trauma. They were examined meticulously and carefully looked for any erythema or evidence of koebnerization. Out of the 50 patients, 20 patients with mucosal vitiligo over lips, 28 patients with focal vitiligo over dorsum of foot/hand, eyelid, cheeks, forearm and legs, 1 segmental vitiligo and 1 acrofacial vitiligo patients were included in the study. They were given pre-treatment consultation, information sheet about the surgical procedure and fully explained about the pros and cons of the surgery. After their full understanding and willingness only they were enrolled in the study. Pre-operative assessment and investigations were done. INCLUSION CRITERIA : • Stable vitiligo. • Willingness to be enrolled in the study. EXCLUSION CRITERIA : • Active vitiligo. • Infection. • H/s/o Herpes labialis. • Keloidal tendency. • Bleeding disorders. • Overlying altered thick skin- due to PUVA. • Hypothyroidism. • Pregnant and lactating females. CONCLUSION : To conclude Miniature Punch grafting and Split skin grafting are easy to perform, cost effective procedure that gives excellent results with minimal side effect provided we choose the right candidate for treatment. • Both these surgical methods do not require any laboratory technicians, expensive equipments or chemicals. • The results obtained depended upon patient selection with achievement of excellent pigmentation when the lesions are stable, focal or segmental and over areas with minimum mobility. • Miniature punch grafting is not only an easy, safe and least expensive method, but it is one of the most effective treatment options in treating stable and recalcitrant vitiligo. • Cobblestoning, the commonest side effect with punch grafting, can be minimized by using miniature punch grafting technique using 2-2.5mm punches. • Though miniature punch graft is easy and safe, pigment dispersion takes a longer time to achieve. So immediate cosmetic results are less compared to split skin grafting hence patient preference is more for the latter. • This problem can be minimized by the use of adjuvant therapies. • Split thickness skin grafting gives almost immediate results, but requires expertise in harvesting the graft. • Pigmentation is uniform with split thickness skin grafting. • Cobblestoning, common with minigrafting, does not occur in SSG. • Adjuvant therapy is not routinely needed for split skin grafting • Graft necrosis though is more common with split skin grafting, but repigmentation was also observed in such grafts due to the adjuvant effect of dermabrasion done for preparation of the graft site. • The most significant factor influencing success with split skin graft was mobility of the recipient site with poor results at highly mobile recipient sites. • Thus, even in the absence of adequate resources, both the surgeries can be done with almost similar good results.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Split Skin Grafting ; Miniature Punch Grafting ; Vitiligo.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 02:54
Last Modified: 03 Mar 2018 01:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/5965

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