Surgical Therapies

Surgical therapies can be used for areas of stable vitiligo. There are a variety of grafting and transplant procedures used. Small grafts of skin can be removed from normal skin that is in an unseen area and grafted onto areas with vitiligo. Light is often used to stimulate the pigment to spread beyond the grafted area. Some regions, like India, are using small samples of normal skin and culturing either melanocytes or a combination of melanocytes and keratinocytes that are then spread over the areas of vitiligo that have been abrased to allow the cells to penetrate. The area is covered with a dressing for some period of time. Surgical therapies can often be used with success on segmental vitiligo, as the vitiligo is usually stable after the initial spread. Due to the risk of the skin trauma activating the vitiligo, surgical therapies are rarely performed unless the patient has been stable for at least a year. Side effects of these surgical therapies can be spreading in the area where the graft/sample is taken, a cobblestone or patchwork effect, or scarring.

Surgical therapies include grafts and transplants:

• Mini-punch grafting takes small full-thickness grafts and places them in the depigmented area, with topical PUVA used to stimulate pigmentation. The main downside is a cobblestone effect.
• Thin split-thickness grafts take a thinner slice but are similar to the mini-punch grafting. They require general anesthesia and are often successful for the lips/hands. Scarring may occur in both donor and grafted areas.
• Suction blister grafting separates the epidermis from the dermis with a suction device that causes blisters. The epidermis is then placed on an abraded vitiligo area. Areas between the grafts may remain hypopigmented, but scarring is usually minimal.
• Transplant therapies include transplantation of pure melanocytes or melanocytes and keratinocytes together. In either technique the area with vitiligo that is to receive the transplant is roughed up or abraded, sometimes with a laser, then a dressing with the melanocyte mixture is placed on the site and covered until the area heals. Some form of light is often used to help stimulate the pigment to spread out.
• Transplantation of pure melanocytes requires a growth medium, which can lead to inconsistent results depending on the growth medium used and could possibly lead to malignant development of melanocytes. An area of donor skin is removed and the melanocytes are separated, then cultured on the growth medium.
• Transplanting melanocytes and keratinocytes together is a much easier technique that does not require the use of growth factors since the keratinocytes help produce more melanocytes. Both the melanocytes and keratinocytes are separated out from the donor skin.