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   Introduction
   Material and Methods
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SHORT COMMUNICATION
Year : 1992  |  Volume : 58  |  Issue : 5  |  Page : 328-330

Punch grafting in vitiligo




Correspondence Address:
S S Pandey


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Source of Support: None, Conflict of Interest: None


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  Abstract 

Thirty three patients of 15-35 years age having various types of stable vitilligo from 1-15 years duration were selected for punch grafting. Vitiligo lesions in all these patients were relatively refractory to systemic PUVA therapy tried for a period of 1 to 8 years. The technique of punch grafting was modified from the method described by Falabella and Behl. Complete responses was observed in 10 patients, still under follow up for 1 year and partial response in rest 23 patients who are under observation.


Keywords: Vitiligo, Punch grafting


How to cite this article:
Pandey S S, Shukla V K. Punch grafting in vitiligo. Indian J Dermatol Venereol Leprol 1992;58:328-30

How to cite this URL:
Pandey S S, Shukla V K. Punch grafting in vitiligo. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Feb 23];58:328-30. Available from: http://www.ijdvl.com/text.asp?1992/58/5/328/3838



  Introduction Top


The various medical therapeutic modalities used for the treatment of vitiligo have certain limitations. Dermatosurgical modalities are thereby required specially in stable or nonprogressive type of vitiligo refractory to medical therapies.

In this study punch grafting technique has been used and evaluated for treatment of stable vitiligo.


  Material and Methods Top


The criteria for selection was based on patients having nonprogressive type of vitiligo not responding to systemic or topical PUVA therapy tried for a minimum period of 1 year.

Informed consent was obtained from each patient. The punch grafting technique has been modified from the method described by Falabella [2],[3],[4] and Behl. [5]

The donor site was selected preferably over the normal skin of gluteal area, inner aspect of thigh, or arm. Both donor and recipient sites were prepared and draped. Then xylocaine 2% with adrenaline was injected. The depigmented skin from the recipient site was punched out as one punch per cm 2 using 3 mm punch device and then the area was compressed to control bleeding. The required number of 4 mm punch grafts were taken from donor site and implanted over the recipient punched out site. The recipient site was then covered with micropore adhesive tape and dressing was done. The donor site was also dressed.

Patients were called again after 15 days to change the dressing. Follow up at monthly interval was done.


  Results Top


A total of 33 vitiligo patients (11 men, 22 women; age 15 - 35 years) were selected for punch grafting [Table - 1].

All cases had skin type IV (some times burns, always tans). One third of the cases had lesions for 1-5 years, one third had it for 5-9 years, while rest third had it for 1015 years [Table - 2]. Majority of the patients (75.8%) had mixed type of vitiligo,

18 percent had generalized (vulgaris and acrofacial) type while only 6 percent had localised type of vitiligo [Table - 2].

The vitiligo lesions in all 33 patients were refractory to systemic PUVA therapy tried for a minimum period of 1 year and maximum of 8 years. The size of the grafted vitiligo lesions ranged from 1 cm 2 to 15 cm 2 area. The punch grafting was done mostly in the lesions present over extremities, trunk and back. Out of these 33 patients, complete repigmentation was observed in 10 patients, who are still under follow up for the last 1 year [Figure - 1][Figure - 2]. In rest 23 patients pigmentation is spreading slowly as being observed for last 3 to 6 months [Figure - 3][Figure 4]. No recurrence or scar has beer seen either at donor or recipient site in any of the patients. It has been observed that minimum 4-5 months period is required to repigment 1 cm 2 area around a punch graft.


  Comments Top


In those vitiligo lesions which are known to be relatively refractory to PUVA therapy, shifting to other modes of medical or surgical therapies is needed. Among various surgical approaches tried in vitiligo punch grafting is the simplest and least aggressive method. The procedure can be tailored both with regard to the physician's working time and the patient's requirements [6]. Also, here the repigmentation follows the usual centrifugal pattern of spread of pigmentation and matches in complexion too. This method can be performed with less number of instruments and suturing is not required at all. Therefore there is almost no chance of postoperative scar.

 
  References Top

1.Nordlund J J, Lerner AB. Vitiligo : what is it ? is it important ? JAMA 1978 ; 239: 1183-7.  Back to cited text no. 1    
2.Falabella R. Repigmentation of leukoderma by minigrafts of normal pigmented, autologous skin. J Dermatol Surg Oncol 1978; 4: 916-9.  Back to cited text no. 2  [PUBMED]  
3.Falabella R. Repigmentation of segmental vitiligo by autologous minigrafting. J Am Acad Dermatol 1983; 9: 514-21.  Back to cited text no. 3  [PUBMED]  
4.Falabella R. Repigmentation of stable leukoderma by autologous minigrafting. J Dermatol Surg Oncol 1986 ; 112: 172-9.  Back to cited text no. 4    
5.Behl PN. Repigmentation of segmental vitiligo by autologous minigrafting. J Am Acad Dermatol 1985; 12: 118-9.  Back to cited text no. 5  [PUBMED]  
6.Falabella R. Grafting and transplantation of melanocytes for repigmenting vitiligo and other types of leukoderma. Int J Dermatol 1989;128:363-8.  Back to cited text no. 6    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

    Tables

[Table - 1], [Table - 2], [Table - 3], [Table - 4]

This article has been cited by
1 Evolution and evaluation of autologous mini punch grafting in vitiligo
Lahiri, K.
Indian Journal of Dermatology. 2009; 54(2): 159-167
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2 Pigmentary Disorders in Western Countries
van der Veen, J.P.W.
Dermatologic Clinics. 2007; 25(3): 449-455
[Pubmed]
3 Autologous transplantation techniques for vitiligo: How to evaluate treatment outcome
Van Geel, N.A.C., Ongenae, K., Vander Haeghen, Y.M.S.J., Naeyaert, J.M.
European Journal of Dermatology. 2004; 14(1): 46-51
[Pubmed]
4 A Comparative Study of Punch Grafting Followed by Topical Corticosteroid Versus Punch Grafting Followed by PUVA Therapy in Stable Vitiligo
Barman, K.D., Khaitan, B.K., Verma, K.K.
Dermatologic Surgery. 2004; 30(1): 49-53
[Pubmed]
5 A systematic review of autologous transplantation methods in vitiligo
Njoo, M.D., Westerhof, W., Bos, J.D., Bossuyt, P.M.M.
Archives of Dermatology. 1998; 134(12): 1543-1549
[Pubmed]



 

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