Flashcards in Vitiligo surgery Deck (62):
The absence of progression of disease for a period of 1 year is generally regarded as an optimum period for stable disease.
Thin split-thickness skin or suction blisters are the most effective and safest techniques for the treatment of vitiligo.
Minigrating is the easiest technique for treating vitiligo and has a low rate of adverse effects.
F Highest rate of adverse effects.
Lips, nipples, genitals and acral areas of vitiligo respond best to medical therapy.
F These areas are particularly resistance to medical therapy.
Surgery is indicated in vitiligo when medical treatment is unsatisfactory.
Vitiligo lesions that respond poorly to medical therapy include: all non-hairy areas.
Vitiligo lesions that respond poorly to medical therapy include: non-mucosal areas.
F Mucosal areas.
Vitiligo lesions that respond poorly to medical therapy include: non-bony areas.
F Bony areas.
Vitiligo lesions that respond well to medical therapy include:
F Responds poorly.
Vitiligo lesions that respond poorly to medical therapy include: lesions with leukotrichia.
Elderly patients and patients with segmental vitiligo respond inadequately to medical therapy.
Surgical treatment of vitiligo is advocated in stationary, stable and resistant cases, after failure of proper medical management.
Surgical treatment of vitiligo is capable of stopping the progression of the disease.
F It only provides pigmentation.
The basic principle of vitiligo surgery is transplantation of autologous melanocytes from unaffected pigmented skin to lesional skin.
The outcome of surgical treatment of vitiligo is good in stable, localised disease, and poor in unstable vitiligo, extensive disease and acral lesions
A test graft may be considered whenever there is doubt about vitiligo disease stability.
It is easy to predict the stability of disease progression of vitiligo in children.
After surgical treatment of vitiligo, complete pigmentation is seen.
F Incomplete, particularly at edges.
Well-defined and hyperpigmented borders of the vitiligo lesions indicate stable disease.
T Ill-defined borders = unstable.
Presence of follicular or marginal repigmentation is an indicator of unstable disease.
F Stable disease.
The entire donor area needs to be infiltrated with local anaesthesia prior to vitiligo surgery.
F This can result in surface irregularities causing the graft to be of uneven thickeness.
Minigraft punching involves harvesting small 1.5-2mm punch grafts from the pigmented donor skin and directly transplanting them on the vitiliginous recipient sites.
F 1.2 or 1.5mm
The typical donor site for minipunch grafting is an area of normal skin in close proximity to the recipient site.
F Upper lateral thigh or gluteal area.
At the recipient site for minipunch grafting, the punched out chambers are placed at a distance of 5-10mm from each other.
Recipient chambers should be the same depth as the size of the donor graft.
F Slightly deeper so that the graft fits snugly and doesn’t pop out.
After minipunch grafting, perigraft repigmentation is expected to start in about 3-4 weeks.
After minipunch grafting, the treated lesion is expected to be completely repigmented within 3-6 months, depending on the location of the treated area.
After minipunch grafting, phototherapy should be started immediately.
F Start anytime after 1 week.
With minipunch grafting, a 1mm donor graft size can repigment an area 25 times larger than the graft itself.
With minipunch grafting and post-op nbUVB, an area 56 times the graft area may be repigmented.
Complications after minipunch grafting at the recipient site include cobblestone appearance, polka-dot appearance, variegated appearance, colour mismatch, static graft (absence of pigment spread), depigmentation of graft, perigraft halo or achromic fissure, graft dislodgement or rejection, and hypertrophic scar and keloid formation.
There are generally no complications seen after minipunch grafting at the donor site.
F Can get scarring, keloid/hypertrophic scars, koebnerisation, spread of disease.
Polka-dot appearance is the most common complication after minipunch grafting.
Cobblestoning after minipunch grafting tends to be permanent.
F Improves with time.
Minipunch grafting on the face and lips should be performed with smaller punches (1.2 or 1mm).
Suction blister epidermal grafting involves obtaining epidermal grafts from the donor site using prolonged suction – these are then transplanted over denuded vitiliginous areas.
Prolonged suction causes a column of negative pressure, resulting in a split at the dermoepidermal junction and blister formation
The donor site for suction blister epidermal grafting is typically either the upper lateral thigh or gluteal area.
F Medial upper arm, flexor forearm or thigh.
Anaesthesia is required at the donor site for suction blister epidermal grafting.
Prolonged suction in suction blister epidermal grafting causes a split at the dermoepidermal junction and blister formation.
In suction blister epidermal grafting, negative pressure of about 300-400mmHg is used.
In suction blister epidermal grafting, suction is maintained for 20 minutes.
F Maintained until single blister of sufficient size is formed.
In suction blister epidermal grafting, the recipient site can be denuded with dermabrasion, Er:YAG laser or CO2 laser.
After suction blister epidermal grafting, pigment spread takes place gradually in 4-6 months covering the entire area.
In suction blister epidermal grafting, the grafts need to be secured with sutures.
F Secure with tissue glue at the edges.
Possible complications of suction blister epidermal grafting include hyperpigmentation, perigraft halo, incomplete pigmentation and graft slough.
The main advantage of suction blister epidermal grafting is that a thin graft yields excellent cosmetic results with no scarring at the donor site.
Suction blister epidermal grafting is not time consuming.
F Can take about 1.5-2.5hrs to form blisters.
Suction blister epidermal grafting can be used only to treat small areas at a time.
Targeted phototherapy, 308nm excimer laser and IPL can be used to treated vitiligo.
The most common causes of failure of graft uptake are inadequate immobilisation of the graft, haematoma formation under the graft and secondary infection.
It is impossible to avoid perigraft halo or achromic fissures of depigmented skin between grafts.
F Can extend SSGs 1-2 mm beyond vitiliginous skin.
Minipunch grafting should not be used in acral areas.
F This is one of its indications.
Minipunch grafting has a higher success rate than thin SSG.
F SSG 78-91% vs minimpunch 68-82%.
Suction blister grafting is suitable for treating vitiligo of the lips.
Thin split-thickness skin grafting can be used to treat all areas of vitiligo.
Systemic PUVA therapy is routinely required after thin split-thickness skin grafting for the treatment of vitiligo.
In the eyebrows and beard area, the hair should be plucked prior to surgery for the treatment of vitiligo in order to delay regrowth (which can lift up grafts).
Apart from vitiligo, other causes of leukoderma in the genital region include postinflammatory depigmentation due to genital herpes and contact leukoderma due to condoms.
In acral areas, dermbrasion should be superficial prior to grafting.
F Deeper to get adequate vascular bed.
The excimer laser (308nm) with a fiber-optic delivery system emits coherent, pulsed light of high-power density