Surgical Management

Surgical management of vitiligo is suggested by doctor when all the other medical treatments fail to respond well. There are various surgical techniques to treat vitiligo, including:

  • Suction blister grafting: Thin epidermal grafts will be taken from the suction blisters from the donor site. In most cases, the donor site will be either buttocks or thighs. The first process of the method is to create blisters on the pigmented skin using suction. The top portion of the blisters will be cut out and then transplanted to the depigmented skin area. Prior to that, a blister of equal size will be created and removed in the depigmented area. Scarring, lack of repigmentation, cobblestone appearance etc. are the main risks of the procedure.

  • Follicular unit grafting: This technique uses single-hair follicular units prepared/harvested from a suitable donor area in hair transplantation. In the case of vitiligo management, the harvested follicular units are cut and transplanted into vitiligo lesions. This procedure will have the benefits of a punch graft and blister grafting.

  • Smash grafting: A partial thickness graft will be taken and smashed to use in this method. For this, a surgical blade will be used. The smashes tissue will then transplanted on to the derma braded skin. A special powder or corrugated tube dressing will be used to cover and protect the smash graft.

  • Split thickness grafting: A split thickness graft will be taken from the donor area using a dermatome/Humby’s knife/Silver’s knife or a simple shaving blade. This will be transplanted on to the derma braded areas. Vitiligo can be tackled using this method in a single sitting.

  • Non-cultured epidermal suspensions: A split-thickness graft will be taken from the donor site. The graft will be then incubated overnight. On the next day, the cells will be separated using a kind of solution called tryspin-EDTA. The separated cell will be then centrifuged to prepare a suspension. This cell suspension will be then applied to the derma braded vitiligo affected lesions. This procedure is best for relatively large area of vitiligo.

  • Melanocyte culture transplant: This is one of the advanced techniques used to treat vitiligo. In this procedure, a split-thickness graft will be taken from the donor site and incubated in an appropriate culture medium to grow the melanocytes or the keratinocytes-melanocyte combination in vitro. The procedure is a complex one and it require highly skilled and experienced professionals to perform.

  • Miniature punch grafting: In this procedure, a full-thickness punch graft of 1.0-2.0 mm diameter will be taken from the donor site and then transplanted on to the recipient vitiligo lesions. The recipient area will be treated with PUVA/PUVA-sol or topical steroids. This will lead to spreading of pigment from the transplanted punches to the surrounding skin. Over time, the whole area will get pigmented. This procedure is easy to perform and can tackle relatively larger vitiligo area.