Suction Blister Epidermal Grafting Research Articles

Surgical pearl: Use of micropore tape for easy harvestation and transfer of suction blister epidermal graft

Epidermal graft produced by suction is useful in treating vitiligo. However, it is very difficult to handle thin, flimsy, and translucent epidermis due to its in-curling and wrinkling properties. This is due to the hemispherical blister roof surface area which is twice its circular base. The correction of the epidermal surface and its resizing is a cumbersome and time-consuming task during epidermal grafting. To combat these problems, the blister roof is patched with micropore adhesive tape as a novel technique for harvestation and transfer of the suction blister graft.

To study the efficacy of autologous non-cultured nontrypsinized epidermal cell grafting (Jodhpur technique) by using of suction blister membrane in stable vitiligo.

This study aimed to evaluate the efficacy of autologous non-cultured non-trypsinized melanocytekeratinocyte grafting (JT) with suction blister membrane as biological dressing in stable vitiligo patches. The study was conducted at Mathura Das Mathur Hospital (MDM), Jodhpur, on 43 patches of Stable vitiligo. It was a prospective single-arm interventional study. All patients were examined clinically and history and informed consent were taken before starting the procedure. About 95% of patches showed >50% repigmentation with 83.72% having good to excellent repigmentation. About 88% of patches showed good color matches with an excellent decline in Dermatology Life Quality Index (DLQI). No serious complication was observed in the present study. The most common complication observed both in the donor and recipient area was pain. Our study indicates that combining JT with suction blister epidermal grafting is a comparatively effective technique in terms of good repigmentation (≥75% extent of repigmentation), color match, fewer side effects, good patient satisfaction, and DLQI reduction.

Long-Term Effects and Prognosis Following Suction Blister Epidermal Grafting in Vitiligo Patients.

Suction blister epidermal grafting (SBEG) is currently one of the most prevalent surgical methods for stable vitiligo. To investigate the long-term outcomes of vitiligo patients who underwent SBEG and to explore risk factors associated with postoperative relapse. A retrospective cohort study was conducted in patients who underwent SBEG in our department between January 2016 and December 2022. Treatment outcomes, including repigmentation rate, adverse events, and postoperative relapse, were surveyed via telephone interview or out-=patient visit. Multivariate logistic regression models were used to assess the potential risk factors for postoperative relapse. Statistical significance was assumed at P < .05. A total of 253 patients were included with a repigmentation rate of 96% (243/253) after grafting. Common adverse events included cobblestone-like appearance (73.1%, 185/253) in the donor site, perigraft halo (46.2%, 117/253), and cobblestone-like appearance (26.1%, 66/253) in the recipient site. Postoperative relapse occurred in 20.1% of patients over a mean time of 29.7 months after grafting. Nonsegmental type of vitiligo and coexistence of autoimmune diseases were risk factors for postoperative relapse. SBEG is an effective surgical treatment for vitiligo with high repigmentation rate and good safety profile. Nonsegmental vitiligo and comorbid autoimmune diseases may increase the risk of postoperative relapse.

Feasibility of High-Cellular-Resolution Full-Field, Artificial-Intelligence-Assisted, Real-Time Optical Coherence Tomography in the Evaluation of Vitiligo: A Prospective Longitudinal Follow-Up Study.

Vitiligo, a psychologically distressing pigmentary disorder characterized by white depigmented patches due to melanocyte loss, necessitates non-invasive tools for early detection and treatment response monitoring. High-cellular-resolution full-field optical coherence tomography (CRFF-OCT) is emerging in pigmentary disorder assessment, but its applicability in vitiligo repigmentation after tissue grafting remains unexplored. To investigate the feasibility of CRFF-OCT for evaluating vitiligo lesions following tissue grafting, our investigation involved ten vitiligo patients who underwent suction blister epidermal grafting and laser ablation at a tertiary center between 2021 and 2022. Over a six-month period, clinical features, dermoscopy, and photography data were recorded. Utilizing CRFF-OCT along with artificial intelligence (AI) applications, repigmentation features were captured and analyzed. The CRFF-OCT analysis revealed a distinct dark band in vitiligo lesion skin, indicating melanin loss. Grafted areas exhibited melanocytes with dendrites around the epidermal-dermal junction and hair follicles. CRFF-OCT demonstrated its efficacy in the early detection of melanocyte recovery and accurate melanin quantification. This study introduces CRFF-OCT as a real-time, non-invasive, and in vivo evaluation tool for assessing vitiligo repigmentation, offering valuable insights into pigmentary disorders and treatment responses.

Ultrathin Skin Grafting Versus Suction Blister Epidermal Grafting in the Treatment of Resistant Stable Vitiligo: A Self-Controlled Comparative Study.

Surgical therapies are effective methods to treat resistant stable vitiligo, with each method having advantages and disadvantages. This study aimed to compare the efficacy and safety of ultrathin skin grafting (UTSG) and suction blister epidermal grafting (SBEG) to treat stable vitiligo. A total of 15 patients with 45 vitiligo patches were recruited. Each vitiligo patch was divided in half; 1 half was treated by UTSG, whereas the other half was treated by SBEG. The patients were followed up monthly for 3 months to assess the repigmentation rate, relative melanin index (RMI), and relative erythema index (REI) at different timepoints. Excellent repigmentation was observed in 97.8% of patches that underwent UTSG and 93.3% that underwent SBEG. The RMI and REI at 1, 2, and 3 months after the grafting procedure did not significantly differ between the 2 methods. At the recipient site, incomplete fall-off of the graft occurred in 4.4% of patches that underwent UTSG, whereas a "cobblestone appearance" was observed in 66.7% of patches that underwent SEBG. UTSG caused fewer complications at the donor site than SBEG. Compared with SBEG, UTSG is faster and achieves better cosmetic outcomes at the recipient and donor sites.

Utilization of Our Toolkit: A Systematic Review and Meta-analysis of Surgical Therapies in Vitiligo Treatment.

Although vitiligo is often treated medically, there is increasing evidence for surgical therapies. Overlap with in-office surgical therapies that are already employed for other dermatologic conditions suggest that there is a significant opportunity to expand dermatologists' therapeutic repertoire for vitiligo. To systematically review the efficacy of nonphototherapy surgical treatments for vitiligo in comparative or placebo-controlled trials. A systematic review for surgical treatments for vitiligo was conducted. Primary outcomes were treatment success (>75% repigmentation) and failure (<25% repigmentation) for which meta-analyses were performed. Adverse effects were noted. The Cochrane risk of bias tool was used to assess study quality. Surgical treatments reviewed included platelet-rich plasma, microneedling, ablative therapies, and surgical modalities. Seventy-three studies with 2,911 patients were included. The repigmentation benefits and adverse events are summarized. Meta-analyses suggest benefits for ablative laser therapies or microneedling in combination with narrowband ultraviolet B (NB-UVB) and for suction blister epidermal grafting over punch grafting. The addition of microneedling or ablative laser therapy to NB-UVB phototherapy may improve repigmentation with minimal adverse effects. Surgical therapies, such as suction blister grafting and punch grafting, may offer the highest likelihood of repigmentation but have a risk of adverse effects including scarring and hyperpigmentation.

Ballooned glove for smooth epidermal graft transfer in vitiligo

Suction blister epidermal grafting is a popular modality of surgical treatment in vitiligo. However, the suction blister epidermal grafts being thin causes difficulty in transfer from the donor site to the recipient site. Various tools have been suggested for graft transfer, like fine gauze, the use of gloved fingers, glass slides, and acetate sheets. These modalities have their own advantages and disadvantages. For example, a glass slide is rigid and difficult for curved surfaces of recipient sites, 1 Ashique K.T. Kaliyadan F. When half-slide can deliver double efficiency for blister grafting in vitiligo. J Am Acad Dermatol. 2020; 83: e181-e182https://doi.org/10.1016/j.jaad.2019.04.056 Google Scholar acetate sheets are not firm enough, and a gloved finger provides a small surface area. 2 Laxmisha C. Thappa D.M. Surgical Pearl: gloved finger as a transport platform for epidermal graft of suction blister. J Am Acad Dermatol. 2007; 57: S118-S119https://doi.org/10.1016/j.jaad.2005.04.022 Google Scholar To overcome these problems, we suggest using a ballooned glove to transfer suction blister epidermal grafts from the donor to recipient site.

Efficacy and safety of traditional and surgical treatment modalities in segmental vitiligo: A review article.

Segmental vitiligo (SV) is a distinctive variant of vitiligo that is usually resistant to traditional treatments. Therefore, surgical therapies are mainstay of treatment in this type of vitiligo. To date, there is no review article or systematic review that evaluates specifically efficacy of treatment modalities on SV. To evaluate current evidence regarding efficacy and safety of traditional and surgical treatment modalities in SV. We conducted a search in PubMed, Embase, Web of science, and Google Scholar for key words of "vitiligo" AND "segmental" AND "treatment" OR "therapy" OR "surgical treatments" OR "medical treatments" OR "laser" OR "phototherapy". Inclusion criteria were English literature that investigated efficacy of different treatments on three or more cases on SV from January 2000 until July 2021. A total of thirty-four articles were selected for detailed assessment. Different treatment modalities include medical treatment [systemic corticosteroid (SCS), topical CS (TCS), and topical calcineurin inhibitors (TCI)], phototherapy [narrow band-ultraviolet B (NB-UVB), psoralen and UVA (PUVA) and psoralen+solar exposure (PUVASOL)], laser/lights [helium-neon and Excimer laser/light (EL)] and surgical treatments [punch graft (PG), follicular graft, suction blister epidermal grafting (SBEG), spilt-thickness skin graft (STSG), and cultured/non-cultured-melanocytes-keratinocytes transplantation (MKTP)]. There were few randomized controlled trials (RCT) evaluating the efficacy of treatments in SV. Therefore, future high quality studies are required for better assessment of various treatment modalities in SV. Results of current evidence indicate resistance of SV to traditional therapies unless in patients with short duration of vitiligo. Therefore, surgical interventions are the first-line of treatment in refractory cases, long-standing disease, or presence of leukotrichia in depigmented patches.

A comparative study of suction blister epidermal grafting and automated blister epidermal micrograft in stable vitiligo

The automated blister epidermal micrograft (ABEM) is a newly introduced surgical transplantation for refractory vitiligo. Comparative analysis of other surgical methods is lacking. We conducted a retrospective study to compare the efficacy, safety, and experience of ABEM with conventional suction blister epidermal graft (SBEG). A total of 118 anatomically based vitiligo lesions from 75 patients were included. The primary outcome was the degree of repigmentation; the patient and operator experience were evaluated. SBEG had a significantly greater incidence of repigmentation (p < 0.001), as measured by the Physician Global Assessment, as well as improvements in the Vitiligo Area Scoring Index, particularly on the face/neck area (p < 0.001). ABEM, on the contrary, had reduced donor harvest time, a better patient operative experience, and more significant Dermatology Life Quality Index improvements. In a subgroup of 38 lesions from ten patients who received both SBEG and ABEM concomitantly, there was no difference in the degree of repigmentation in the same recipient area. Overall, the degree of repigmentation for SBEG is higher than ABEM, especially in the mobilized region, and the cost is less expensive. On the contrary, ABEM requires less procedure learning curve and can supply a greater transplanting zone with shorter donor site recovery. Understanding the benefits and drawbacks of two blister grafting procedures is essential for optimal surgical outcomes for vitiligo grafting.

Treating Vitiligo at the Angle of Lips: A Narrative Review.

Vitiligo is a common autoimmune depigmentary disorder seen among Indian patients. It has a significant impact on the self-esteem of the patient. Specific sites including acral areas, joints, and lips are usually resistant to medical therapy and thus transfer of melanocytes is mandatory for the treatment. Vitiligo at the angle of lips is distinct from the vitiligo on other sites, with respect to response to therapy, lack of hair follicles, and high mobility of the area. Our aim was to review the various therapeutic modalities available for the treatment of vitiligo at this site. In our narrative review, we searched databases including PubMed, Google Scholar, and EBSCO with a full strategic search with keywords "Vitiligo," "leucoderma," "mucosal vitiligo," "lips," "labial," "angle of lips," "Minipunch grafting," "Suction Blister epidermal Grafting," "SBEG," "Micropigmentation," "tattooing," and "Excision" from 2005 to 2021. The relevant articles were extracted and included in the review. Various modalities including suction blister grafting, miniature punch grafting, split-thickness grafting, and micropigmentation have been reviewed with their advantages and disadvantages. Various potential modalities of therapy have also been proposed in the review.

Use of disposable syringe for transfer of graft in suction blister epidermal grafting

Suction blister epidermal grafting is a common surgical procedure for the treatment of vitiligo. The conventional technique for the transfer of graft requires a glass slide. Some challenges faced while doing this maneuver include the following: (1) transferring the graft on the glass slide requires skill and expertise; (2) realigning of the graft on the slide is required while transferring onto the recipient site; (3) the graft occasionally gets wrinkled, and it becomes difficult for the surgeon to distinguish the dermal side of the graft; and (4) it becomes difficult to align the right-angled glass slide according to the contour of the recipient site.

Efficacy of a wound-dressing biomaterial on prevention of postinflammatory hyperpigmentation after suction blister epidermal grafting in stable vitiligo patients: a controlled assessor-blinded clinical study with in vitro bioactivity investigation.

Postinflammatory hyperpigmentation (PIH) is a common disfiguring complication following inflammatory dermatoses and cosmetic procedures in dark-skinned individuals. Anti-inflammatory and repairing agents targeting primary inflammation and injury are becoming promising choices for preventing PIH. The aim of this active-controlled, assessor-blinded, intra-individual monocentric study was to evaluate the preventive effect of a wound-dressing biomaterial, mussel adhesive protein (MAP) in the suction blister-induced PIH model. Twenty Chinese patients underwent suction blister epidermal grafting had defined wound areas to receive a topical MAP spray or a potent corticosteroid cream once daily for seven consecutive days after operation. In situ semi-quantitative evaluations of inflammation and pigmentation were achieved by Mexameter, reflectance confocal microscopy and dermoscopy on week 1, week 4, and week 12. Topical application of MAP exerted remarkably inhibitory effect on PIH comparable to fluticasone propionate, manifested as significantly lower melanin index and papillary contrast measured by Mexameter and confocal microscopy on week 12 compared to untreated sites. Although MAP exhibited moderate anti-inflammatory effect weaker than fluticasone propionate, MAP-treated sites healed faster than steroid-treated and untreated sites. The biological activity of MAP was further studied in UVB-irradiated HaCaT cell model, which revealed MAP decreased the expression of UVB-induced α-melanocyte stimulating hormone (α-MSH) and pro-inflammatory cytokines (IL-1α, IL-6, COX-2). It also protected HaCaT cells from UVB-induced cell death and apoptosis. In conclusion, MAP could be a novel postoperational wound dressing preventing PIH associated with skin inflammation and injury.

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.

Repigmentation of Eyebrow Leukotrichia in Segmental Vitiligo Treated with Suction Blister Epidermal Grafting Following Hair Plucking.

Repigmentation of Eyebrow Leukotrichia in Segmental Vitiligo Treated with Suction Blister Epidermal Grafting Following Hair Plucking.

Efficacy of suction blister epidermal grafting with concomitant phototherapy in vitiligo treatment.

IntroductionThere are many surgical methods for vitiligo treatment that have been used for over 30 years. Suction blister epidermal grafting (SBEG) is considered one of the simplest and most effective of them.AimTo determine how effective suction blister grafts with concomitant phototherapy are in vitiligo treatment.Material and methodsThe study was conducted on 10 patients with vitiligo that was resistant to previous treatment including phototherapy in monotherapy. Involvement of affected sites was different for every patient. We used cryotherapy for blistering at the recipient site and an automatic suction device for blistering at the donor site. The blister was separated from the donor site and fixed with dressing to the recipient site. After removing the final dressing (about 7 days after SBEG) patients started phototherapy (6 patients had UVB 311 nm and 4 had PUVA). All patients treated with UVB 311 nm were qualified for treatment in our clinic and the method was chosen according to expert recommendations from the European Dermatology Forum (EDF) Guidelines for Vitiligo where narrowband (NB) UVB is the phototherapy of choice. Three patients who had PUVA therapy were treated with this method in other clinical centers and sent to us only to undergo SBEG. One patient had previously received UVB 311 nm for 3 months, which showed no effects. Repigmentation of lesions was evaluated at 3 and 6 months after the surgical procedure.ResultsTen patients (9 females with a mean age of 36.88 years and 1 man aged 39 years) were enrolled in the study. Nine patients showed progressive repigmentation at 3 and 6 months follow-up with a rate varying from 13 to 76% (mean: 44.5%) and 35 to 100% (mean: 67.5%). One patient showed 5% depigmentation at a visit after 6 months in comparison to the follow-up visit 3 months after SBEG.ConclusionsWith this technique, patients who did not respond to the usual treatments showed very good repigmentation over a 6-month follow-up. There were no side effects such as scarring.

Suction blister epidermal grafting for neuropathic ulcer in leprosy

Leprosy is one of the leading causes of chronic wound cases, especially in endemic countries, where the successfulness of disease elimination has not been followed by reduced rates of leprosy-related disabilities. Chronic nonhealing ulcers are often difficult to treat and have a significant impact on the patient's quality of life as well as an economic burden. Suction blister epidermal grafting (SBEG) was invented as an alternative approach for recalcitrant cases with some advantages above conventional skin grafting techniques. However, availability of sophisticated technologies to harvest grafts is a common problem in most facilities in Indonesia along with prohibitive cost for most patients who are below the poverty line. To overcome such limitations, we implemented a simplified SBEG procedure using daily medical instruments and equipments to provide an affordable service to a neuropathic plantar ulcer patient due to leprosy with satisfying result.

Suction Blister Epidermal Grafting for Vitiligo Involving Angles of Lip: Experience of 112 Patients.

Background:Lip vitiligo is usually resistant to medical modalities of treatment, and in all these cases, surgery offers a hope. Suction blister grafting (SBG) has been tried since long for lip vitiligo with high rate of success. There have been no long-term follow-up studies of patients with SBG at a difficult-to-treat site like angles of lip, which prompted us to conduct this study.Aims and Objectives:To assess the pigmentation rate and patient satisfaction of SBG on vitiligo involving angles of lip.Materials and Methods:This is a prospective study conducted on 112 patients with stable vitiligo involving angles of lip. SBG was carried out in all the patients using the standard procedure. Patients were advised to apply topical psoralen followed by sun exposure (PUVASOL) for 8–12 weeks after operation. The patients were followed up at 3, 6, 12, 18, and 24 months for assessment of pigmentation and overall satisfaction.Results:We found a pigmentation success rate of 83.7%, 84.9%, 85.7%, 78.3%, and 77.8% in the patients who were followed up at 3, 6, 12, 18, and 24 months, respectively. A total of 77.8% of patients who came for follow-up at the end of 24 months were very happy with the treatment.Discussion:Our data show clearance of vitiligo and persistence of pigmentation gained through SBG in 77.8% of cases at the end of 2 years as well as excellent patient satisfaction in the cohort of patients who followed up with us.Conclusion:SBG is an easy and cost-effective way of repigmentation of vitiligo involving angles of lip.

Optimizing suction blister epidermal graft technique in the surgical treatment of vitiligo.

Surgical management of vitiligo is considered an excellent terapeutic option for recalcitrant cases, provided the disease is stable and there is absence of Koebner phenomenom. Among surgical modalities, Suction Blister Epidermal Graft is a low cost and effective option (65 to 100% repigmentation can be achieved in up to 80% of patients). We describe how it can be optimized by using an alternative suction equipment, by customization of graft format and by application of an anesthetic technique that substantially reduces procedure time.

028 Is suction blister epidermal grafting a simple and reliable way to screen patients with large area vitiligo for ReCell treatment?

028 Is suction blister epidermal grafting a simple and reliable way to screen patients with large area vitiligo for ReCell treatment?

A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device.

Introduction: Epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization. The development of an automated suction blister epidermal graft (SBEG) harvesting device may facilitate clinical utilization of this technique. The authors present a case series of multimorbid patients who were poor surgical candidates and were treated with this technique.Methods: A retrospective review of all patients treated with CelluTome™​ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX) prior to May 2016 at our institution was conducted.Results: A total of 12 patients underwent 14 epidermal grafting procedures. Multiple comorbidities were identified, including smoking (33%), immunosuppression by immunotherapy or steroids (25%), chronic venous insufficiency (25%), diabetes mellitus (25%), malignancy (25%), polysubstance abuse (17%), HIV/AIDS (17%), and peripheral artery disease (8%). Among the two acute wounds (≤ 3 months) and 10 chronic wounds, the average wound size was 49.1 cm2 (± 77.6 cm2) and the median wound duration was 5.7 months (interquartile range: 4.1 - 15.8 months) before SBEG was attempted. These complex wounds had failed prior therapies, such as local wound care (100%), incision and drainage (58%), vacuum-assisted closure (33%), split-thickness skin graft (16%), and hyperbaric oxygen (8%). Following the procedure, all donor sites healed within one week. Three patients were lost to follow-up. Of the remaining nine patients, four patients had complete resolution of their wounds at a median follow-up of 13.1 weeks (interquartile range: 6.8-17.3 weeks). Among those with partial resolutions, the average wound size was 4.2 cm2 (± 2.1 cm2) with an average wound reduction of 79% (± 23%). No donor or recipient site complications were observed.Conclusions: The automated SBEG harvesting device is an effective and safe option for treating complex non-healing wounds in multimorbid patients who may be poor surgical candidates. This procedure demonstrates minimal contraindications to its use and donor or recipient site complications.