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Mini punch and Bulla Grafting for Vitiligo

    What is vitiligo?

  • Vitiligo is a chronic skin disorder that causes areas of skin to lose colour. It presents as depigmented (white) patches. Exposed body sites, such as the face, elbows, knees, hands and feet, are often involved, resulting in significant cosmetic concerns. Vitiligo is usually treated with creams and tablets, or by phototherapy. Vitiligo may fail to improve or clear with these treatments.
  • Surgical treatment options can be considered in patients with stable vitiligo.
  • What is the goal of vitiligo surgery?

  • The goal of vitiligo surgery is to achieve complete repigmentation that cosmetically matches the surrounding normal skin.
  • Appropriate patient selection is vital in ensuring the best outcome, as not all patients or vitiliginous skin sites are suitable for surgery. Prior to surgery the following patient factors should be considered:
  • The age of the patient
  • Patient expectations
  • Disease stability
  • Size and location of the vitiligo patch
  • The proposed method of surgery
  • The proposed donor site

  • Miniature punch grafting

    • Miniature punch grafting is one of the most commonly used techniques, due to its simplicity and efficacy. Bits of skin about 2 mm in diameter are punched out from the donor site on buttock or thigh and placed on the donor site of vitiliginous skin, where recipient chambers have also been created by punches.
    • Potential immediate complications of miniature punch grafting include:
      • Loss of graft tissue
      • Infection

      • Mid- to long-term complications of miniature punch grafting include:
      • Hyperpigmentation
      • Imperfect colour matching
      • Peripheral depigmentation (halo effect)
      • Graft rejection
      • Keloid and hypertrophic scar at the donor or graft site
      • Cobblestone appearance (more common with larger punch biopsies)
      • Persistent vitiligo

      • Suction blister grafting

      • In suction blister grafting, negative pressure is applied to the normally pigmented donor site to promote the formation of multiple blisters.
      • Blisters may be raised using one of the following options:
        • Syringe
        • Suction pump
        • Suction cups
        • Negative pressure cutaneous suction chamber system

      • The bases of syringes of sizes 10 ml and 20 ml are coated with vaseline and are applied on the donor site. It usually takes 1.5 to 2.5 hours for the development of blisters. The roofs of the blisters (the grafts) are surgically removed, cut to the appropriate size and shape, and transplanted onto the prepared recipient site.

      • Good cosmetic results can be achieved, with minimal scarring of the donor site or cobblestoning at the recipient site. Suction blister grafting is generally safe, easy to perform and inexpensive, with good success rates. However, it can also be very time consuming, and can be performed only on small areas of skin.

      • Complications of suction blister grafting are limited to: