Microskin Grafting for Vitiligo (eBook)

Dr Gupta has been practicing, Plastic, Cosmetic and Reconstructive surgery since 1984. He is invited for his lectures on plastic surgery and regional anesthesia all over Northern India and has teaching programmes for Plastic Surgeons (Hypospadias, Pinna re-construction, Burn contractures, Rhinoplasty), Occuloplastic Surgeons (Eye tumours and Ptosis, Lid re-construction), Gynecologists (Reconstructive vaginal surgery and Cosmetics Gynecological surgery), Anesthesiologists (Techniques in Regional Anesthesia) and Dermatologists (Dermato Surgical Techniques, IPL & Laser Procedures).

Preface 5
Acknowledgements 6
Contents 7
Abbreviations 11
Part I: Surgical Management 12
Chapter 1 13
Surgical Therapies 13
1.1 Introduction 13
1.2 Course and Prognosis 13
1.3 Surgical Therapies 14
1.4 Split Thickness Skin Sheet Grafting 14
1.5 Minipunch Grafting 14
1.6 Suction Blisters Epidermal Grafting 15
1.7 Transplantation of Cultured or Noncultured Melanocytes 15
References 15
Chapter 2 17
Concept of the Stability of Vitiligo 17
2.1 Stability 17
2.2 Minigraft Test7,8 18
References 19
Chapter 3 20
Classification of Surgical Treatment Modalities 20
3.1 Classification of Tissue Grafts2 20
3.1.1 Split-Thickness Skin Grafts (STSG) 20
3.1.2 Full Thickness Skin Graft (FTSG) 20
3.2 Classification of Cellular Grafts 21
References 21
Chapter 4 22
Excision with Primary Closure 22
Chapter 5 24
Thin and Ultra Thin Split Thickness Skin Grafts (STSG-UT, STSG-T) 24
5.1 Split-Thickness Skin Grafts (STSG) 24
5.2 Thin Split-Thickness Skin Graft(STSG-T) and Ultra-Thin Split-Thickness Skin Graft (STSG-UT) 24
References 26
Chapter 6 28
Split Thickness Skin Graft-Suction Blister Epidermis (STSG-BE) 28
6.1 Micro Blister Grafting 31
References 32
Chapter 7 33
Full Thickness Skin Graft (FTSG) 33
7.1 Punch Grafting 33
7.2 Minipunch Grafting 36
7.3 Hair Follicle-Grafting 37
References 37
Chapter 8 38
Cellular Grafts 38
8.1 Noncultured Epidermal Cell Suspension (NCES) 38
8.2 ReCell7 39
8.3 Transplantation of Cultured Autologous Melanocytes9,10 39
8.4 CellSpray XP 40
8.4.1 CellSpray 40
8.5 Cultured Epithelial Grafts (CE)16–18 40
References 41
Part II: Microskin Grafting 42
Chapter 9 43
What Is a Microskin Graft? 43
9.1 How Was I Inspired to Start Micro Skin Grafting? 44
References 44
Chapter 10 46
Preparation of Recipient Vitiliginous/Leukodermic Areas 46
10.1 Dermabrasion of Recipient Vitiliginous Areas 46
10.2 Eye Protection Be Worn During Dermatological Surgery 47
References 48
Chapter 11 49
Superficial Dermabrasion of Vitiliginous Skin 49
11.1 What is Dermabrasion? 49
11.2 Anesthesia for Dermabrasion 49
11.3 Mechanical Dermabrasion Tools 49
11.3.1 Dermabrader 49
11.4 Diamond Fraises 49
11.5 Dermabrasion Wire Brushes 50
11.6 Dermabrasion Procedure 50
11.7 Complications of Dermabrasion 51
Reference 51
Chapter 12 52
Donor Area Selection 52
12.1 Donor Site Preparation 53
Chapter 13 54
Skin Graft Harvesting 54
13.1 Skin Harvesting Tools 54
13.1.1 Free-Hand Knives 54
13.1.2 Types of Dermatomes 54
13.1.2.1 Knives 54
13.1.2.2 Drum Dermatome 54
13.1.2.3 Powered (Electric or Air) Dermatomes 55
13.1.3 Silver’s Skin Graft Knife Handle 55
13.1.4 Sober Hand Dermatome 55
13.2 Grafting with a Modified Safety Razor 55
13.2.1 Humby Skin Grafting Knife 55
13.2.2 Cutting Split Skin Grafts 55
13.2.3 Preoperative Details 56
13.3 Preoperative Preparation 56
13.4 Equipment 56
13.5 Anesthesia for Skin Grafting 56
13.5.1 Eutectic Mixture of Lidocaine and Prilocaine (EMLA) 57
13.6 Positions for Cutting Grafts 57
13.7 Cutting the Graft 58
13.7.1 Graft Take 60
13.8 The Donor Site Care 61
13.9 Postoperative Care for Skin Grafts 61
13.9.1 Storing Grafts 61
Chapter 14 62
Microskin Grafting Tools 62
14.1 Muslin Tulle Gras 62
Chapter 15 64
Techniques of Microskin Grafts Distribution on Ablated Vitiliginous Areas 64
15.1 Microskin Grafting for Repigmentation of Vitiligo by Direct Spread Method 64
15.2 Microskin Grafting by Floatation Method 65
15.3 Microskin Grafting by Spraying Method in Extensive Vitiligo Management 67
15.3.1 Variations in Spraying Method 67
15.3.1.1 Spray MSGs on Muslin Sheet and then Turn Over it on Abraded Vitiliginous Area 67
15.3.1.2 Directly Spray on the Wound with the Pumping Device 68
15.3.1.3 Comparison: Floatation vs. Spraying 69
15.3.1.4 Turn Over (Reversing) the MSGs to Change Their Orientation 70
15.3.1.5 Points to be Noted 71
Part III: Step-by-Step Microskin Grafting Techniques 72
Chapter 16 73
Microskin Grafting by Direct Spread Method 73
16.1 Case 1 (Segmental Vitiligo-Cheek) 73
16.2 Case 2 (Segmental Vitiligo-Left Upper Eyelid) 74
16.3 Case 3 (Vitiligo Vulgaris-Right Foot) 75
16.4 Case 4 (Palmer Vitiligo-Left Hand) 75
16.5 Case 5 (Bindi Leukoderma-Contact Depigmentation from Adhesive) 76
16.6 Case 6 (Vitiligo-Right Foot) 76
16.7 Case 7 (Segmental Vitiligo-Right Side of Face) 77
16.8 Case 8 (Segmental Vitiligo-Forehead) 78
16.9 Case 9 (Segmental Vitiligo-Left Cheek) 78
16.10 Case 10 (Segmental Vitiligo-Left Eyebrow and Forehead) 79
16.11 Case 11 (Vitiligo-Fingers of Both Hands) 79
16.12 Case 12 (Vitiligo-Upper Eyelids) 80
16.13 Case 13 (Naevus Depigmentosus) 80
16.14 Case 14 (Post Burn Dyschromia-Right Side of Face) 81
Chapter 17 83
Microskin Grafting by Floatation Method 83
17.1 Case 1(Post Burn Leukoderma: Cheek) 83
17.2 Case 2 (Vitiligo Vulgaris) 85
17.3 Case 3 (Segmental Vitiligo: Mini Punch Grafts vs. Microskin Grafts) 88
17.4 Case 4 (Acrofacial Vitiligo) 90
Chapter 18 94
Microskin Grafting by Spraying Method in Extensive Vitiligo Management 94
18.1 Case 1(Stable Segmental Vitiligo-Cheek) 94
18.2 Case 2 (Vitiligo Vulgaris) 95
18.2.1 First Microskin Graft Operation 96
18.2.2 Second Microskin Graft Operation Performed in the Same Patient After 63 Days 100
18.2.3 Third Microskin Graft Operation done on fifth day of second operation 101
18.3 Case 3 (Extensive Vitiligo) 108
Part IV: Surgical Outcomes 117
Chapter 19 118
Complications Involved in Various Surgical Techniques 118
19.1 Recipient Area Complications 118
19.2 Donor Area Complications 121
Chapter 20 124
Outcome of Various Techniques of Vitiligo Surgery 124
20.1 Surgical Outcome and Benefits of Microskin Grafting 125
20.1.1 What Need to Be Followed in Microskin Grafting? 125
20.1.2 What are the Benefits of Microskin Grafting? 126
20.1.3 Donor to Recipient Area Expansion Ratio 127
20.1.4 Caution! 127
References 129
Appendix 1 130
Index 132