A comparative study of suction blister epidermal grafting and automated blister epidermal micrograft in stable vitiligo

The automated blister epidermal micrograft (ABEM) is a newly introduced surgical transplantation for refractory vitiligo. Comparative analysis of other surgical methods is lacking. We conducted a retrospective study to compare the efficacy, safety, and experience of ABEM with conventional suction blister epidermal graft (SBEG). A total of 118 anatomically based vitiligo lesions from 75 patients were included. The primary outcome was the degree of repigmentation; the patient and operator experience were evaluated. SBEG had a significantly greater incidence of repigmentation (p < 0.001), as measured by the Physician Global Assessment, as well as improvements in the Vitiligo Area Scoring Index, particularly on the face/neck area (p < 0.001). ABEM, on the contrary, had reduced donor harvest time, a better patient operative experience, and more significant Dermatology Life Quality Index improvements. In a subgroup of 38 lesions from ten patients who received both SBEG and ABEM concomitantly, there was no difference in the degree of repigmentation in the same recipient area. Overall, the degree of repigmentation for SBEG is higher than ABEM, especially in the mobilized region, and the cost is less expensive. On the contrary, ABEM requires less procedure learning curve and can supply a greater transplanting zone with shorter donor site recovery. Understanding the benefits and drawbacks of two blister grafting procedures is essential for optimal surgical outcomes for vitiligo grafting.

AUTOLOGOUS SUCTION BLISTER EPIDERMAL GRAFTING FOR CHRONIC LEG ULCERS

Non healing ulcers are a burden to the patient as they are difcult to treat. They also affect patient's quality of life. A series of 2 patients – one with chronic venous ulcer and other with diabetic foot ulcer were included. Epidermal grafts were harvested and applied using Cellutome epidermal harvesting system (KCI) with no anesthesia. After transferring the harvest of epidermal blisters, 4 layer compression bandaging was given. Both the patients tolerated the procedure with no complications involving donor as well as recipient sites. Photographs were taken during various phases of healing. 1 week follow up showed 63% reduction in wound area. Donor site was completely healed by this time. Reduction in ulcer size of upto 99% was seen in 8 weeks.

Surgical interventions for vitiligo

Since nonsurgical treatment of vitiligo is not always successful, surgical interventions are viable options for patients with refractory vitiligo. Surgical treatment is a method in which melanocytes of normal skin are transplanted into vitiligo lesions and provided as a repigmentation source. Such treatments are primarily divided into tissue grafting and cellular grafting, depending on the nature of the graft. Tissue grafting includes split-thickness skin grafting, suction blister grafting, punch grafting, hair follicle transplantation, and smashed-skin grafting. Cellular grafting includes non-cultured epidermal cell suspension transplantation, non-cultured follicular cell suspension transplantation, and cultured epidermal cell suspension transplantation. Among these, suction blister grafting and micro-punch grafting have been widely performed for localized refractory vitiligo, and non-cultured epidermal cell suspension transplantation is adopted as the standard treatment for extensive vitiligo. Research on cultured cellular grafting to treat larger vitiligo areas is also ongoing. Selecting patients with stable vitiligo that has not spread for over 12 months is the most critical factor in the surgical outcome. It is also important to choose an appropriate surgical modality for each patient, and a combination of various procedures often improves the overall outcome. In conclusion, surgical intervention can be an effective and safe option for patients with vitiligo refractory to conventional treatments. Non-cultured epidermal cell suspension transplantation, which was denied by New Health Technology Assessment in Korea, should be approved to benefit patients with refractory vitiligo.