Punch Grafting Research Articles

Prediction of response to surgical therapy in nonsegmental vitiligo based on an immunohistochemical cutoff value

Background Objective assessment of stability is still lacking in nonsegmental vitiligo (NSV).Objective To suggest immunohistochemical cutoff values that can predict a good response to surgical therapy of NSV cases.Patients and methods Fifteen active and 15 stable NSV cases were included in the present study. A 3-mm perilesional biopsy from perilesional skin was obtained for immunohistochemical staining for CD8, CD45RO, and FoxP3. Mini punch graft was done for all cases, and response was assessed after 6 months. Good responders had spread of pigment more than 1 mm, and poor responders had no spread of pigment or loss of color. Comparison of immunohistochemical findings according to response to surgery was done, and a cutoff value was calculated when feasible.Results Ten active and 10 stable cases continued 6 months of follow-up. Loss of color occurred in all active cases, whereas five patients had no spread and five patients had good response in the stable group. Good responders had a significantly lower level of CD8+ (P=0.001) and CD45RO+ cells (P=0.020), with cutoff values of 7 and 11 cells/high-power field, respectively. No significant difference was found in FoxP3+ cells.Conclusion A suggested cutoff value of 7 CD8+ T cells and 11 CD45RO+ cells/high-power field can predict a good response to surgery in NSV.

Dermoepidermal grafting obtained by shave excision of papule formed post punch grafting in vitiligo: improvement of the cobblestone pattern

Dermoepidermal grafting obtained by shave excision of papule formed post punch grafting in vitiligo: improvement of the cobblestone pattern

A self-controlled comparative study of mini punch graft versus suction blister epidermal graft in the treatment of stable vitiligo

Background Mini punch graft (MPG) and suction blister epidermal graft (SBEG) are both effective for stable vitiligo, but there is a lack of self-controlled comparison between these two procedures. Objective To compare the efficacy and safety of MPG and SBEG in stable vitiligo. Materials and methods Twenty-three patients were enrolled in this study. A single white patch from each patient was divided into two halves, one half was treated by MPG, while the other half was treated by SBEG (blister or dermabrasion for recipient site), followed by narrow-band UVB irradiation twice a week for 3 months. The repigmentation rate, relative melanin index (RMI), and relative erythema index (REI) were measured at different time points. Results The repigmentation rate of grafts was 98.7% (312/316) in MPG, 98% (49/50) in SBEG (blister for recipient site) and 99.3% (272/274) in SBEG (dermabrasion for recipient site). The RMI and REI at different time points had no statistical difference between MPG and SBEG. Cobblestone appearance was the predominant complication in SBEG. For MPG, superficial scar occurred in two cases in recipient sites and no obvious side effects in donor sites. Conclusions MPG is much easier, faster with less side effects in donor site.

Mini punch graft for chronic leg ulcers, case series

Chronic leg ulcer can caused morbidity and decreased quality of life. Previous study reported leg ulcer affect up to 3% of adult population worldwide Mini punch graft is one of therapeutic options of chronic leg ulcer. This surgical method aimed to include epidermal and dermal tissue with an absence of terminal hair follicles. Previous study mentioned that this procedure stimulated healing in many cases of chronic leg ulcers with total reepithelialization.In this article, the application of multiple mini punch grafts onto two case of extensive leg ulcers caused by burn injury and diabetic ulcer are reported. Split thickness skin graft with mini punch graft require skin donor from inguinal area. The donor were placed onto the ulcer. After several weeks, the ulcer area that had been mini punch grafted show reepethelialization.

Punch grafting in postsurgical wounds

Skin tumors usually occur in sun-exposed areas. If direct closure after tumor removal is not possible, the defect can be reconstructed with a flap or graft. Another option is to plan a secondary intention closure. This alternative is common in locations, such as scalp or leg, or when part of a flap or graft becomes necrotic.

A comparative study between suction blistering graft, mini punch graft, and hair follicle transplant in treatment of patients with stable vitiligo

Background: Vitiligo is an acquired disfiguring common depigmented skin disease.Objectives: This study aimed to compare the clinical efficacy and safety of suction blistering graft, mini punch and hair follicle techniques in treatment of patients with stable vitiligo.Methods: Thirty patients with stable vitiligo were included. Patients were divided into 3 groups, in group (A) 10 patient underwent suction blistering technique, in group (B) 10 patients underwent mini punch technique and in group (C) 10 patients underwent hair follicle technique. Then all patients in the three techniques were subjected to narrow-band ultraviolet B (NB-UVB) phototherapy for 3 months. All patients were assessed by determining the percentage of repigmentation and Dermatology Life Quality Index (DLQI) before and 3 months after the operation.Results: The percentage of repigmentation of vitiligo in suction blister technique was significantly higher than both mini punch and hair follicle techniques (p value .001 and .0001 respectively). There was a statistically significant difference between the three techniques regarding DLQI score after operation (p value = .0001).Conclusion: This study concluded that suction blistering technique is more effective and safe than mini punch technique and hair follicle technique in treatment of stable vitiligo.

Leg ulcers (ulcus cruris): The frequent macrovascular causes

Leg ulcers (ulcus cruris): The frequent macrovascular causes Abstract. Four pathologies make up the macrovascular etiologies of leg uclers: Venous leg ulcers (50 %), mixed venous-arterial leg ulcers (20 %), arterial leg ulcers (5 %), and Martorell hypertensive ischemic leg ulcer (5 %). The remaining 20 % concern a large array of other etiologies. Every leg ulcer requires vascular (arterial and venous) work-up, that can be completed with microbiology, biopsy, and more in-depth internal diagnostics, as indicated. Venous leg ulcers are treated with compression therapy. Incompetent saphenous veins and tributaries are abolished if the deep venous system is patent. Occluded iliac veins are recanalised and stented, as possible. Refractory venous leg ulcers are grafted with split skin or punch grafts, depending on their surface. Extensive dermatolipofasciosclerosis may be tangentially removed by shave therapy or fasciectomy, that can be combined with negative pressure wound treatment (NPWT). Skin equivalents are an alternative to treat superficial venous leg ulcers that fail to epithelialise. Their indication in the treatment of more complex leg ulcers still needs to be better investigated and understood. The use of dermal matrices leads to more stable scars. Mixed venous-arterial leg ulcers heal slower and recur more frequently. Compression needs to be reduced. Refractory cases require arterial revascularisation, to transform the mixed venous-arterial into a venous leg ulcer. Arterial leg ulcers require arterial revascularization and split skin graft. Martorell hypertensive ischemic leg ulcer is still underrecognised and often confounded with with pyoderma gangrenosum, which leads therapy into a wrong direction. Necrosectomy, antibiotic treatment in the presence of relevant bacterial superinfection, and repeated split skin grafts eventually heal the vast majority of these extremely painful and potentially mortal wounds.

Leg Ulcers: Expanding the Differential

Cutaneous lower extremity ulcerations are major source of morbidity and mortality. It can be challenging to identify an underlying etiology. This review provides a systematic framework for generating a thoughtful differential diagnosis and workup approach. We also highlight recent discoveries in the pathophysiology and treatment approaches of leg ulceration. Venous leg ulceration is being treated with a number of promising new modalities including pentoxifylline, statin therapy, topical timolol, connexin-43 peptide antagonists, photodynamic therapy, and punch grafting. The role of vitamin K deficiency is gaining prominence with regard to calciphylaxis. Recognition of key risk factors and subtle physical exam findings can serve as clues to the underlying mechanism of cutaneous ulceration and direct a targeted workup for underlying systemic disease that may be ameliorated with appropriate therapy.

Motorized 0.8-mm micropunch grafting for refractory vitiligo: A retrospective study of 230 cases

Punch grafting for vitiligo is time-consuming and can result in cobblestone-like appearances. We devised a motorized 0.8-mm micropunch grafting procedure to overcome these limitations. To assess the therapeutic effectiveness and adverse events associated with micropunch grafting in refractory vitiligo. We retrospectively reviewed 230 cases in 208 patients with stable vitiligo who underwent motorized 0.8-mm micropunch grafting during January 2015-August 2017. Treatment success was defined as ≥75% repigmentation, and factors associated with the outcome were assessed. Overall, 181 of 230 lesions (78.7%) achieved treatment success after a median of 6months with postoperative excimer therapy. Lesions on the face and neck, and disease stability of ≥12 months were good prognostic factors for treatment success. Common adverse events were color mismatch (24.8%) and cobblestone appearance (18.3%). Overall, the treatment was tolerable. This was a retrospective study. Micropunch grafting using a motorized 0.8-mm punch can successfully treat refractory vitiligo with short procedure times and excellent outcomes. This technique could be a rapid and convenient surgical option with acceptable adverse events and is promising for treating refractory vitiligo on an outpatient basis, particularly in patients who are unlikely to tolerate prolonged surgery.

Punch grafts to treat lower limb intractable sores.

Lower limb recurrent ulcers, usually caused by prolonged decubitus, trauma, diabetes or burns, may not heal with conventional clinical or surgical treatment. Frequently, laminated skin grafts do not integrate with the recipient layer, and the only alternatives are neighbor microsurgical flaps. These have higher morbidity and create secondary defects, to be corrected with skin grafts, when fasciocutaneous or miocutaneous segments are removed for the treatment of the primary defect. We describe the non-conventional use of punch grafts in the treatment of lower limb ulcers, when conventional skin laminated graft failed, without the use of flaps. Since this is a very successful technique, its use should be considered as a valuable alternative for the treatment of recurrent lower limb ulcers. It is a simple and easy-learned technique that may be used by different surgeons, even in remote places without correct specialized hospital facilities.

Prise en charge des cicatrices hypopigmentées post-brûlure

Permanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications. The PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation. Sixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared. Thin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.

Comparison of Repigmentation of Stable Vitiligo via Punch Grafting, Thin-thiersch’s grafting and Suction Blister Grafting

Background: Vitiligo is defined as an acquired melanocytopenia of obscure aetiology and is characterized by circumscribed hypomelanosis and depigmentation of skin and hair which is often progressive. The aim of present study is to compare between 3 surgical modalities i.e. miniature punch grafting, thin split-skin thickness grafting and suction blister grafting and to experiment a novel method according to the site, size and location of the lesion and to study the extent of re-pigmentation after doing these procedures and comparison of the results in patients of stable vitiligo. We also aim to assess the complications and disadvantages of different surgical techniques. Methods: The study was conducted on total 60 vitiligo patients, who were divided into 3 groups of 20 each, in the age group of 15-60 years, attending Dermatology Department of Katihar Medical College in the span of 2 yearsResults. Results are comparable overall but vary considerably according to site of lesions. Punch grafting is very good for mobile areas like elbow, ankle and other joints; Thin – thiersch’s skin grafting gives better results for flat areas like trunk, thigh, arms and face while Suction blister grafting gives satisfactory results for lips vitiligo and also over small, oval lesions over flat sites. Conclusions: Thus, it can be finally concluded from this study that the surgical modality for treating a case of vitiligo cannot be generalized. Every patient should be evaluated individually according to anatomical site involved, size and shape of lesion, time required to achieve pigmentation, infrastructure available and patient’s preferences.

Efficacy of Miniature Punch Grafting Followed by Puvasol Therapy in Refractory Stable Vitiligo

Introduction: Vitiligo affects approximately 2% of the worldwide population regardless of race, ethnic background or gender. When the medical methods are not successful, surgical procedures may be considered with the aim of placing a new source of pigment cells to reinitiate melanogenesis within the affected areas. This study was conducted to evaluate the efficacy of combining punch grafting followed by PUVASOL therapy in vitiligo patients. After punch grafting patients are given PUVA/PUVASOL exposure.Objective: To study the efficacy of miniature punch grafting followed by PUVASOL therapy in refractory stable vitiligo.Material and Methods: The present study was conducted in the Department of Dermatology and Venereology of Dayanand Medical College & Hospital, Ludhiana from May 2005 to March 2007. Fifteen patients of chronic stable vitiligo not responding to medical treatment and attending the outpatient department of dermatology were included in study. Appropriate statistical methods were used to analyse the data.Conclusion: Patients subjected to Miniature Punch Grafting showed more than 80% acceptance in all selected age groups and among both the sex. There was an inverse relationship between number of grafts inserted and rejection rate. Most common side effect seen was cobblestoning (60%) with few patients showing graft displacement and hematoma formation too.

Hair-follicle Transplant Into Chronic Ulcers: A New Graft Concept

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

Immunosuppressed cutaneous District: The finale of the fascinating farrago of confounding responses?

Immunosuppressed cutaneous District: The finale of the fascinating farrago of confounding responses?

Autologous Epidermal Grafting Using a Novel Negative Pressure Epidermal Harvesting System in a Case of Stable Vitiligo

Vitiligo is a common pigmentary disorder of the skin with a great amount of social stigma attached to it. Though various medical modalities are available for the treatment of stable vitiligo, surgical modality remains the treatment of choice for stable and localized vitiligo. The surgical options range from simple punch grafting to the recent epidermal harvesting methods using a negative pressure unit. Although successful use of multiple methods of epidermal grafting has been reported, most of them are cumbersome and time-consuming. The new automated epidermal harvesting system now commercially available involves a tool that applies both heat and suction concurrently to normal skin to induce epidermal micrografts. Hence it serves as a safe, quick and cost-effective method without anesthesia, with a very minimal downtime for healing and requires an optimal expertise. The duration of repigmentation seems to be faster and more uniform compared to other procedures. We would like to share our experience with the negative pressure epidermal harvesting method in a patient with stable vitiligo.

Hair follicle–containing punch grafts accelerate chronic ulcer healing: A randomized controlled trial

A prominent role of hair follicle-derived cells in epidermal wound closure is now well established but clinical translation of basic research findings is scarce. Although skin punch grafts have been used as a therapeutic intervention to improve healing of chronic leg ulcers, they are normally harvested from nonhairy areas, thus not taking advantage of the reported role of the hair follicle as a wound-healing promoter. We sought to substantiate the role of hair follicles in venous leg ulcer healing by transplanting hair follicle-containing versus nonhairy punch grafts. This was a randomized controlled trial with intraindividual comparison of hair follicle scalp grafts and nonhairy skin grafts transplanted in parallel into 2 halves of the same ulcer. Ulcer healing measured as the average percentage reduction 18weeks postintervention was significantly increased (P=.002) in the hair follicle group with a 75.15% (SD 23.03) ulcer area reduction compared with 33.07% (SD 46.17) in the control group (nonhairy grafts). Sample size was small (n=12). Autologous transplantation of terminal hair follicles by scalp punch grafts induces better healing than punch grafts harvested from nonhairy areas. Hair punch grafting is a minimally invasive surgical procedure that appears to be effective as a therapeutic tool for chronic venous leg ulcers.

Optimising size and depth of punch grafts in autologous transplantation of vitiligo and piebaldism: a randomised controlled trial

Background: To date, autologous punch grafting appears to be the easiest and least expensive surgical technique for stable vitiligo and piebaldism. Punch grafting is available worldwide, with no need for specialised instruments. However, no reliable data on efficacy and safety of different punch depths and punch sizes are available.Objective/methods: To compare the efficacy and safety of different punch depths and punch sizes in autologous punch grafting, a randomised controlled trial was performed in 33 patients with vitiligo or piebaldism. In each patient, four depigmented regions were allocated to: 1.5 mm deep grafts, 1.5 mm superficial grafts, 1.0 mm deep grafts, and 1.0 mm superficial grafts. Primary outcome was the total pigmented surface area. Secondary outcomes were Patients’ Global Assessment (PGA) and side effects.Results: Six months after grafting, 1.5 mm grafts showed a significantly larger pigmented surface area compared to 1.0-mm grafts (p < 0.001), though more side effects as well. No significant differences in the total pigmented surface between different punch depths were found. Deep grafts showed more erythema compared to superficial grafts.Conclusion: We recommend 1.5 mm superficial grafts in autologous punch grafting for trunk and proximal extremities in patients with stable vitiligo and piebaldism.

Treatment of a Refractory Skin Ulcer Using Punch Graft and Autologous Platelet-Rich Plasma.

Background. Chronic ulceration of the lower legs is a relatively common condition amongst adults: one that causes pain and social distress and results in considerable healthcare and personal costs. The technique of punch grafting offers an alternative approach to the treatment of ulcers of the lower limbs. Objective. Combining platelet-rich plasma and skin graft enhances the efficacy of treating chronic diabetic wounds by enhancing healing rate and decreasing recurrence rate. Platelet-rich plasma could, by stimulating dermal regeneration, increase the take rate after skin grafting or speed up reepithelialization. Methods and Materials. The ulcer was prepared by removing fibrin with a curette and the edges of the ulcer were freshened. The platelet-rich plasma has been infiltrated on the bottom and edges of the ulcer. The punch grafts were placed in 5 mm holes arranged. The ulcer was medicated with hydrogel and a pressure dressing was removed after 8 days. Results. After a few days the patient did not report more pain. Granulation tissue appeared quickly between implants. Most of the grafts were viable in 2-3 weeks. The grafts gradually came together to close the ulcer and were completed in four months.