Suction Blister Epidermal Grafting Research Articles

Suction Blister Epidermal Grafting for Management of Eyelid Vitiligo

BACKGROUND Suction blister epidermal grafting is an established technique for the treatment of resistant and stable vitiligo especially over small and cosmetically important areas like the face. However, certain areas, such as lips and eyelids, require special considerations because of their anatomic peculiarities. PATIENTS AND METHODS The current study was carried out on six patients of stable eyelid vitiligo, not responding to medical treatment. Suction blister was obtained from the thigh using the suction apparatus and the roof was grafted on to the dermabraded eyelid. Certain precautions were taken during the procedure, which will be highlighted in the current study. RESULTS Response was excellent in all the patients in 3 to 6 months, with no complications. CONCLUSIONS If carried out properly, suction blister technique is the procedure of choice for cosmetically important sites like eyelids.

Epidermal grafting in vitiligo: Influence of age, site of lesion, and type of disease on outcome

Background: The success of suction blister epidermal grafting may be influenced by various factors, all of which have not been studied to date. Objective: We sought to determine the influence of age of the patient, site of vitiligo patch, and type of disease on the outcome of the procedure in our patients and in the cumulative data derived from literature analysis. Methods: This was a retrospective, uncontrolled case series and literature review of suction blister epidermal grafting in patients with stable and recalcitrant vitiligo. All published studies of suction blister epidermal grafting in vitiligo involving 10 or more patients were included in the literature analysis. Results: The procedure was performed in 143 patients. However, sufficient length (6 postoperative months) of follow-up was available in only 117 patients, and only these patients were included for analysis. Only limited information was available about various factors in the majority of published studies. The success rates for generalized and segmental/focal disease in this study were 53% (confidence interval [CI] 42-64) and 91% (CI 81-100), respectively ( P < .001), and in the literature, 61% (CI 46-76) and 88% (CI 82-94), respectively ( P < .01). The success rates in patients aged < 20 years and ≥ 20 years in this study were 82% (CI 67-97) and 58% (CI 48-68), respectively ( P < .05), and in the literature, 100% and 66% (CI 56-76), respectively ( P < .05). There was no significant difference in the success rates achieved on different body sites in this study and in the screened literature. Among adverse reactions, hyperpigmentation in 32% (CI 24-40) and 17% (CI 14-20), infection in 6% (CI 2-10) and 0%, and contact dermatitis in 1% (CI 0-3) and 1% (CI 0-2) of patients were observed in this study and in the analyzed literature, respectively. Conclusions: The results were significantly better in segmental/focal vitiligo than in the generalized type, and in individuals < 20 years of age. However, unlike in medical therapies, localization of the vitiligo patch did not influence the treatment outcome significantly. (J Am Acad Dermatol 2003;49:99-104.)

Surgical Pearl: Autologous biological dressing for epidermal grafting in vitiligo and other achromic disorders

J Am Acad Dermatol 2003;48:430-1.

Horizontal and vertical pigment spread into surrounding piebald epidermis and hair follicles after suction blister epidermal grafting.

Following the earlier description of Carnot and Deflandre in 1896, pigment spread phenomenon in mammals was investigated using immunogenetically marked melanocytes (Billingham and Silver, Quart. Rev. Biol. 1960 35: 1-40; Billingham and Silver, Ann. N.Y. Acad. Sci. 1963 100: 348-363). In spite of a number of similar studies on vitiligo lesions, detailed evaluation of pigment spread in piebald lesions has not been reported. To gain further insight into the pigment spread phenomenon in human skin, five piebald patients were studied, on whom suction blister epidermal grafting therapy onto piebald patches was performed. In the present study, pigmentation of all epidermal grafts from normally pigmented areas spread horizontally. It was also found that pre-existing white hairs in recipient sites became pigmented within 1 year after epidermal grafting. Immunofluorescence studies using melanocyte-specific antibody NKI/beteb revealed the newly induced presence of melanocytes in the newly pigmented hair follicles. Further, to study the possible mechanisms inhibiting melanocyte migration from normal skin into piebald lesions, epidermis was grafted from border zones (containing both normal and piebald skin) into the center of hypopigmented lesions. Melanocytes clearly migrated through the border zone of grafted epidermis into surrounding recipient hypopigmented sites.

Modified technique of suction blistering for epidermal grafting in vitiligo.

Suction blister epidermal grafting is a useful modality of treatment of resistant and stable vitiligo; however, it requires expensive and heavy suction apparatus. This study is an attempt to develop a cheap and small apparatus which can be assembled in the physician's own office. The method was tried in 22 vitiligo/leukoderma patients. The apparatus consisted of a cylindrical funnel connected with a three-way tap, and suction was given by a 50-mL syringe. The pressure inside the suction cup was retained by changing the position of lock of the three-way tap. The pressure was measured by connecting the three-way tap to a vacuum gauge. The apparatus remained adhered to the donor area because of negative pressure. The blister was formed in about 1.5 h. The roof of the blister was grafted onto the dermabraded recipient site. The pigmentation was complete in 20 out of 22 patients. There were no complications. The technique is inexpensive and easy and obviates the need of cumbersome and heavy equipment.