Vitiligo- micrografting

  • Best Results2-6 months
  • Treatment Recovery6-12 days
  • Procedure Time60-120 minutes
  • Skin SpecialistDr Davin Lim
  • Duration of ResultsLong-term
  • AnaestheticLocal
  • Back to Work6 days
  • Cost$$ Medicare

Vitiligo- micrografting

Surgical micrografting is a new method for treating vitiligo. This treatment is considered for patients who have stable vitiligo that is not responsive to conventional treatments like phototherapy &/or topical medications. Micrografting is suitable for small areas of vitiligo. With correct patient selection, its success rate is over 90%.

FactsFacts on micrografting for vitiligo

  • Grafting transfers pigment cells from one area to another
  • The donor site is usually on the thigh or arm
  • A thin micrograft is harvested from this area
  • Grafts are placed on a bed of vitiligo skin
  • R-epigmentation starts a few weeks after the transplant
  • Full re-pigmentation can take 6 months or longer
  • Grafting is limited by surface area, stability of vitiligo & age of the patient

What is surgical micrografting?

This is a new remedy that has been developed over the past decade to transfer pigment cells from one area to another using surgical techniques. Pigment cells from a donor site are transferred to the recipient or vitiligo areas using microsurgical skin grafting.

When is surgical micrografting considered?

Micrografting is an option for vitiligo when –

  • Vitiligo is stable for a minimum of 9 months.
  • When patients fall narrowband phototherapy & creams.
  • In small to medium areas of vitiligo
  • In cases of segmental vitiligo

Surgical procedures have a limited area of coverage. Smaller areas of vitiligo on the face, neck & hands do best. Following surgical procedures, you will still require narrowband phototherapy for best outcomes. Topical creams are occasionally used post-surgery.

What areas of vitiligo can be treated with micrografting?

This surgical treatment can be used for treating stable vitiligo on the face & upper limbs- trunk. Micrografting can also be used to treat lower limb vitiligo, however the healing times are much longer compared to face vitiligo. I do not use this technique to treat genital vitiligo or flexural vitiligo (underarms, groin).

What does the donor site mean, & where is it?

The donor site describes the area where I harvest the pigment cells from. This site is located on your thigh or arm. This is known as autologous melanocyte transfer, meaning a live transfer of pigment cells called melanocytes. In contrast, cultured melanocyte transfer means placing live cells in a dish, waiting 4-8 weeks before transferring them to vitiligo areas.

Davin’s viewpoint on micrografts for vitiligo

Surgical treatment of vitiligo has come a long way. Melanocytes can be repurposed from one site to another. These pigment cells are in the base of the epidermis occupying one in 34 cells. They are also located within the follicular units.

Transfer via grafting can be accomplished using punch grafting (easiest to do). This is of historical importance. Dermal punch grafting however can be a super easy way of determining stability & melanocyte migration. A one-millimetre graft can be placed in the middle of a vitiligo patch. It takes less than 20 seconds to perform. Migration of melanocytes within 0.5 mm takes 5 to 8 months. If pigment cells survived it signifies a good prognosis.

Suction blister & traditional SSG grafts offer better tissue integration. The downside, especially for blister grafting is the very slow melanocyte migration between grafts- typically 5 mm apart. It can take 2-3 years to fully repigment. A patchy or stuck on look is universally seen. The answer? ReCell promises to be a great treatment, but in my experience, it is underwhelming.

Micrografting is probably one of the better solutions, short of autologous in vitro melanocyte cell culture. Grafting can treat 10-15X surface area, however for most cases I hover around 5-7X. Results are predictable in over 90% of cases, & like any other surgical procedures for vitiligo, it takes 12 months or more for results to be seen.

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