Skin seeding technique with 0.5‐mm micropunch grafting for vitiligo irrespective of the epidermal–dermal orientation: Animal and clinical studies

Abstract

Micropunch grafting is the simplest surgical intervention for refractory vitiligo but is tedious and time-consuming. Therefore, we aimed to verify the efficacy and safety of dermal orientation grafting using motorized 0.5-mm micropunch grafting for vitiligo. In a preliminary animal study, 12-week-old rats were used to observe the healing process after the transplantation of dermal orientation grafts with various punch sizes. In a clinical trial, a total of 100 vitiligo patches in 50 patients with stable vitiligo were randomly allocated to motorized 0.5-mm micropunch grafting in epidermal and dermal orientations, respectively. The grafts were implanted at intervals of 5 mm at the recipient site. Treatment success was defined as greater than 75% repigmentation. In the animal study, all grafts were shown to be well integrated into the recipient site within 3 weeks. In the clinical trial, treatment success was achieved in 72% and 76% of the epidermal and dermal orientation groups, respectively; a cobblestone appearance was observed in 4% and 2%, respectively. In conclusion, we demonstrated that this new grafting method irrespective of epidermal-dermal orientation using motorized 0.5-mm micropunch grafting was effective and safe. We have named this the "skin seeding technique" and it differs from traditional punch grafting in that it can be performed regardless of the graft orientation.

Surgical Interventions for Patients With Vitiligo

“…We analyzed a total of 117 unique studies with 8776 unique patients (eTable 1 in the Supplement), including 19 studies with 1631 patients in the punch grafting group, 10 studies with 718 patients in the thin skin grafting group, 29 studies with 2652 patients in the suction blister grafting group, 45 studies with 2209 patients in the noncultured epidermal cell suspension (NCES) group, 9 studies with 185 patients in the noncultured follicular cell suspension (NCFS) group, and 17 studies with 1381 patients in the cultured epidermal cell suspension (CES) group; 11 studies included more than 1 procedure type. The median follow-up duration was 7 (range, 2-108) months.…”

“…Common adverse events included pain, hyperpigmentation at the recipient site, and hypopigmentation at the donor site regardless of the type of the procedure. In punch grafting, cobblestone appearance, milia, and color mismatch were the most common and critical adverse events . In suction blister grafting, perigraft halo, variegated appearance, and color mismatch were frequently reported .…”

“…In punch grafting, cobblestone ap- pearance, milia, and color mismatch were the most common and critical adverse events. [9][10][11][12][13][15][16][17][18]20,[22][23][24]26,27 In suction blister grafting, perigraft halo, variegated appearance, and color mismatch were frequently reported. 10,24,[36][37][38]40,43,45,46,[48][49][50]54,55,57,60 Thin skin grafting was associated with graft contracture, over hanging margin, wrinkles over the graft surface, and perigraft halo.…”

Transplantation procedures in vitiligo: What's new

“…The reason for this is that melanocytes migrate to the basal layer irrespective of the orientation in which they are transplanted. There was no significant difference in either the cobblestone or color mismatch as an adverse effect 16 …”

Surgical modalities of treatment in vitiligo

“…[20] It was recently seen in a study on vitiligo patches in rats that irrespective of the orientation of the transplanted donor graft, the repigmentation was good. [21] Suction blister epidermal grafting [Figure 3].…”