Grafting in Vitiligo: How to Get Better Results
Grafting procedures in vitiligo have become quite popular over the last one or two decades especially in India.
Vitiligo is a common acquired disorder of skin pigmentation characterized by localized loss of skin pigment secondary to melanocyte damage.
In general, grafting techniques in vitiligo are divided into two main groups: Tissue grafting and cellular grafting procedures
Proper selection of the patient is the most important factor for achieving a good cosmetic result with any grafting procedure in vitiligo. The factors that need to be considered are the age of the patient, the site of vitiligo, keloidal tendency and most importantly, the stability of vitiligo
Use thinner grafts so that the upper surface of the grafts remains at the level of the recipient skin
Split thickness skin grafting is nowadays considered to be the surgical method of choice for stable, non-responding vitiligo.
Use ultra-thin grafts of uniform thickness that are free of any dermal tissue.
The procedure differs from a traditional split-thickness skin grafting in that the graft that is used is totally translucent, without any whitish tissue on the undersurface
Dermabrade the skin 1–2 mm beyond the margins of the vitiligo lesion and place the grafts beyond the dermabraded margins to minimize the chances of perigraft halo formation
Secure the grafts firmly at the recipient area with proper dressings and immobilization of the grafted area if needed.
Use of cyanoacrylate or surgical glue along the periphery of the graft has been shown to minimize the chances of graft displacement.
Infiltration anaesthesia at the donor site needs to be avoided as it can lead to an irregular surface and thus interfere with the harvesting of a uniform-thickness skin graft. A ring-block is thus preferred at this site.
Topical anaesthetic creams can be used as an alternate to injectable anaesthetics at the donor and even at the recipient site.