VITILIGO SURGERY

INTRODUCTION:

In India, Vitiligo is considered a social stigma and the affected patient & family ostracized, hence it is important to treat and cure patient fully with all available modalities. Often we come across vitiligo patients who have stop responding to all possible medical therapies or who are responding very slowly to the same. Also, sometimes patient with clinically inactive lesions present for correction of their cosmetic deformity.

Apart from these, smaller group of secondary leucodermas (following thermal or chemical burns,etc) also need correction of the depigmented lesions.When inactive lesions occur on the unexposed, cosmetically unimportant areas, patients are ready to accept those lesions and hence can be left alone. However, frequently such hidden lesions also necessitate treatment, along with those occurring on the exposed sites. In such situations, camouflaging creams for daily application can  be advised, but may not be acceptable to all, due to time consuming application, color mismatch, temporary action and cost factors. In such situation, one can think of surgical management of vitiligo.

Since 1964, various surgical techniques and modifications have been reported to treat recalcitrant but stable vitiligo with permanent and complete repigmentation.

Depigmentation in Vitiligo and secondary leucoderma results due to depletion of local melanocytes following their destruction by underlying disease. The various surgical procedures are designed with either of the following 4 aims;

1)    Introduction of  the artificial pigments into the lesions for permanent camouflage e.g. tattooing.

2)    Removal of the depigmented areas forever e.g. Excision with primary closure.

3)    Repopulation of the depleted melanocytes by various grafts e.g. Thierch’s grafts, ultra thin grafts, suction blister and miniature punch grafts, non cultured epidermal suspension or transplantation, epidermal and melanocyte cultures.

4)    Therapeutically wounding the lesion so as to stimulate the melanocyte from the periphery and the black hair follicles to  the proliferate, migrate and repigment the lesion e.g. therapeutic dermabrasion, laser ablation, cryosurgery, needling, local application of phenol or TCA.

SURGICAL MODALITIES FOR VITILIGO:

1)    Cosmetic Tattooing

2)    Excision & closure

3)    Thin Thierch’s graft

4)    Suction blister technique.

5)    Miniature punch grafting.

6)    Therapeutic wounding—Dermabrasion, Laser ablation,needling,cryosurgery,etc

7)    Ultra thin grafting.

8)    Grafting of non-cultured epidermal suspension.

9)    Skin cultures—autologous, allologous or foetal; either epidermal containing both keratinocytes and melanocytes, or pure melanocytes only.

10)          Others—Trypsinised autograft injection, single hair transplant homologous grafting, etc.

However, certain patient selection criteria should be strictly adhered to before taking any patient for surgical intervention.

PATIENT SELECTION CRITERIA:

1)    Patient should have realistic expectations. Avoid psychologically unstable patients.

2)    Patient not responding adequately to medical line of treatment.

3)    Vitiligo lesions should be strictly stable for last two years i.e. existing lesions should not be expanding and no new lesion should have appeared in the interim.

4)    The stability of the lesion should be confirmed by first doing trial grafting in a small vitiliginous area, 1-2 months before undertaking surgery of the entire lesion.

SUMMARY:

Good cosmetic end results will be obtained by strictly following the patient selection criteria and choosing appropriate surgical techniques depending on each individual case. BY:

DR CHETAN LALSETA

M.D.(Skin & V .D)

DERMATOLOGIST & COSMETOLOGIST

“C POINT”—A UNIT OF MCSPL,

SHRADDHA HOSPITAL,

INDIRA CIRCLE CHOWK,

RAJKOT-360005

www.cpoint.in

www.mcspl.in

www.drlalseta.blogspot.com

09825199585