Gupta Microskin Grafting for Vitiligo

1. Auflage 2009
ISBN: 978-1-84882-605-2
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 135 Seiten

This book has been written to assist not only postgraduate students, but also int- ested dermatologists, general practitioners, and surgeons. During the last two decades, various surgical therapies have been used in the tre- ment of stable refractory vitiligo, but none of them became very popular because of their intrinsic drawbacks, and thus could not be adopted as a standard procedure. There has always been a need for a technique that gives best results without complications. The commonly used surgical procedures for the treatment of vitiligo have been narrated in short and their characteristic drawbacks have been pointed out. The c- lular graft technique is costly, requires a good laboratory and infrastructure, and except for being able to cover a wider vitiliginous area, the ultimate results are no better than tissue grafting technique. I used the small skin particles prepared from ultra thin or thin split thickness skin graft, the so called 'microskin graft,' in the tre- ment of vitiligo effectively with good expansion ratio, i.e., small donor skin to treat big vitiliginous area. This procedure covers the bene? t of cellular and tissue graft, but without their inherent drawbacks. The microskin graft technique has been illustrated with minimum necessary text to explain the steps. This technique is very simple to learn and execute. It is extremely 2 cost effective and can treat very large area up to 1,500 cm in an operative session.

Dr Gupta has been practicing, Plastic, Cosmetic and Reconstructive surgery since 1984. He is invited for his lectures on plastic surgery and regional anesthesia all over Northern India and has teaching programmes for Plastic Surgeons (Hypospadias, Pinna re-construction, Burn contractures, Rhinoplasty), Occuloplastic Surgeons (Eye tumours and Ptosis, Lid re-construction), Gynecologists (Reconstructive vaginal surgery and Cosmetics Gynecological surgery), Anesthesiologists (Techniques in Regional Anesthesia) and Dermatologists (Dermato Surgical Techniques, IPL & Laser Procedures).

Autoren/Hrsg.

Gupta, Devendra K.

Inhaltsverzeichnis

1;Preface;5
2;Acknowledgements;6
3;Contents;7
4;Abbreviations;11
5;Part I: Surgical Management;12
5.1;Chapter 1;13
5.1.1;Surgical Therapies;13
5.1.1.1;1.1 Introduction;13
5.1.1.2;1.2 Course and Prognosis;13
5.1.1.3;1.3 Surgical Therapies;14
5.1.1.4;1.4 Split Thickness Skin Sheet Grafting;14
5.1.1.5;1.5 Minipunch Grafting;14
5.1.1.6;1.6 Suction Blisters Epidermal Grafting;15
5.1.1.7;1.7 Transplantation of Cultured or Noncultured Melanocytes;15
5.1.1.8;References;15
5.2;Chapter 2;17
5.2.1;Concept of the Stability of Vitiligo;17
5.2.1.1;2.1 Stability;17
5.2.1.2;2.2 Minigraft Test7,8;18
5.2.1.3;References;19
5.3;Chapter 3;20
5.3.1;Classification of Surgical Treatment Modalities;20
5.3.1.1;3.1 Classification of Tissue Grafts2;20
5.3.1.1.1;3.1.1 Split-Thickness Skin Grafts (STSG);20
5.3.1.1.2;3.1.2 Full Thickness Skin Graft (FTSG);20
5.3.1.2;3.2 Classification of Cellular Grafts;21
5.3.1.3;References;21
5.4;Chapter 4;22
5.4.1;Excision with Primary Closure;22
5.5;Chapter 5;24
5.5.1;Thin and Ultra Thin Split Thickness Skin Grafts (STSG-UT, STSG-T);24
5.5.1.1;5.1 Split-Thickness Skin Grafts (STSG);24
5.5.1.2;5.2 Thin Split-Thickness Skin Graft(STSG-T) and Ultra-Thin Split-Thickness Skin Graft (STSG-UT);24
5.5.1.3;References;26
5.6;Chapter 6;28
5.6.1;Split Thickness Skin Graft-Suction Blister Epidermis (STSG-BE);28
5.6.1.1;6.1 Micro Blister Grafting;31
5.6.1.2;References;32
5.7;Chapter 7;33
5.7.1;Full Thickness Skin Graft (FTSG);33
5.7.1.1;7.1 Punch Grafting;33
5.7.1.2;7.2 Minipunch Grafting;36
5.7.1.3;7.3 Hair Follicle-Grafting;37
5.7.1.4;References;37
5.8;Chapter 8;38
5.8.1;Cellular Grafts;38
5.8.1.1;8.1 Noncultured Epidermal Cell Suspension (NCES);38
5.8.1.2;8.2 ReCell7;39
5.8.1.3;8.3 Transplantation of Cultured Autologous Melanocytes9,10;39
5.8.1.4;8.4 CellSpray XP;40
5.8.1.4.1;8.4.1 CellSpray;40
5.8.1.5;8.5 Cultured Epithelial Grafts (CE)16–18;40
5.8.1.6;References;41
6;Part II: Microskin Grafting;42
6.1;Chapter 9;43
6.1.1;What Is a Microskin Graft?;43
6.1.1.1;9.1 How Was I Inspired to Start Micro Skin Grafting?;44
6.1.1.2;References;44
6.2;Chapter 10;46
6.2.1;Preparation of Recipient Vitiliginous/Leukodermic Areas;46
6.2.1.1;10.1 Dermabrasion of Recipient Vitiliginous Areas;46
6.2.1.2;10.2 Eye Protection Be Worn During Dermatological Surgery;47
6.2.1.3;References;48
6.3;Chapter 11;49
6.3.1;Superficial Dermabrasion of Vitiliginous Skin;49
6.3.1.1;11.1 What is Dermabrasion?;49
6.3.1.2;11.2 Anesthesia for Dermabrasion;49
6.3.1.3;11.3 Mechanical Dermabrasion Tools;49
6.3.1.3.1;11.3.1 Dermabrader;49
6.3.1.4;11.4 Diamond Fraises;49
6.3.1.5;11.5 Dermabrasion Wire Brushes;50
6.3.1.6;11.6 Dermabrasion Procedure;50
6.3.1.7;11.7 Complications of Dermabrasion;51
6.3.1.8;Reference;51
6.4;Chapter 12;52
6.4.1;Donor Area Selection;52
6.4.1.1;12.1 Donor Site Preparation;53
6.5;Chapter 13;54
6.5.1;Skin Graft Harvesting;54
6.5.1.1;13.1 Skin Harvesting Tools;54
6.5.1.1.1;13.1.1 Free-Hand Knives;54
6.5.1.1.2;13.1.2 Types of Dermatomes;54
6.5.1.1.2.1;13.1.2.1 Knives;54
6.5.1.1.2.2;13.1.2.2 Drum Dermatome;54
6.5.1.1.2.3;13.1.2.3 Powered (Electric or Air) Dermatomes;55
6.5.1.1.3;13.1.3 Silver’s Skin Graft Knife Handle;55
6.5.1.1.4;13.1.4 Sober Hand Dermatome;55
6.5.1.2;13.2 Grafting with a Modified Safety Razor;55
6.5.1.2.1;13.2.1 Humby Skin Grafting Knife;55
6.5.1.2.2;13.2.2 Cutting Split Skin Grafts;55
6.5.1.2.3;13.2.3 Preoperative Details;56
6.5.1.3;13.3 Preoperative Preparation;56
6.5.1.4;13.4 Equipment;56
6.5.1.5;13.5 Anesthesia for Skin Grafting;56
6.5.1.5.1;13.5.1 Eutectic Mixture of Lidocaine and Prilocaine (EMLA);57
6.5.1.6;13.6 Positions for Cutting Grafts;57
6.5.1.7;13.7 Cutting the Graft;58
6.5.1.7.1;13.7.1 Graft Take;60
6.5.1.8;13.8 The Donor Site Care;61
6.5.1.9;13.9 Postoperative Care for Skin Grafts;61
6.5.1.9.1;13.9.1 Storing Grafts;61
6.6;Chapter 14;62
6.6.1;Microskin Grafting Tools;62
6.6.1.1;14.1 Muslin Tulle Gras;62
6.7;Chapter 15;64
6.7.1;Techniques of Microskin Grafts Distribution on Ablated Vitiliginous Areas;64
6.7.1.1;15.1 Microskin Grafting for Repigmentation of Vitiligo by Direct Spread Method;64
6.7.1.2;15.2 Microskin Grafting by Floatation Method;65
6.7.1.3;15.3 Microskin Grafting by Spraying Method in Extensive Vitiligo Management;67
6.7.1.3.1;15.3.1 Variations in Spraying Method;67
6.7.1.3.1.1;15.3.1.1 Spray MSGs on Muslin Sheet and then Turn Over it on Abraded Vitiliginous Area;67
6.7.1.3.1.2;15.3.1.2 Directly Spray on the Wound with the Pumping Device;68
6.7.1.3.1.3;15.3.1.3 Comparison: Floatation vs. Spraying;69
6.7.1.3.1.4;15.3.1.4 Turn Over (Reversing) the MSGs to Change Their Orientation;70
6.7.1.3.1.5;15.3.1.5 Points to be Noted;71
7;Part III: Step-by-Step Microskin Grafting Techniques;72
7.1;Chapter 16;73
7.1.1;Microskin Grafting by Direct Spread Method;73
7.1.1.1;16.1 Case 1 (Segmental Vitiligo-Cheek);73
7.1.1.2;16.2 Case 2 (Segmental Vitiligo-Left Upper Eyelid);74
7.1.1.3;16.3 Case 3 (Vitiligo Vulgaris-Right Foot);75
7.1.1.4;16.4 Case 4 (Palmer Vitiligo-Left Hand);75
7.1.1.5;16.5 Case 5 (Bindi Leukoderma-Contact Depigmentation from Adhesive);76
7.1.1.6;16.6 Case 6 (Vitiligo-Right Foot);76
7.1.1.7;16.7 Case 7 (Segmental Vitiligo-Right Side of Face);77
7.1.1.8;16.8 Case 8 (Segmental Vitiligo-Forehead);78
7.1.1.9;16.9 Case 9 (Segmental Vitiligo-Left Cheek);78
7.1.1.10;16.10 Case 10 (Segmental Vitiligo-Left Eyebrow and Forehead);79
7.1.1.11;16.11 Case 11 (Vitiligo-Fingers of Both Hands);79
7.1.1.12;16.12 Case 12 (Vitiligo-Upper Eyelids);80
7.1.1.13;16.13 Case 13 (Naevus Depigmentosus);80
7.1.1.14;16.14 Case 14 (Post Burn Dyschromia-Right Side of Face);81
7.2;Chapter 17;83
7.2.1;Microskin Grafting by Floatation Method;83
7.2.1.1;17.1 Case 1(Post Burn Leukoderma: Cheek);83
7.2.1.2;17.2 Case 2 (Vitiligo Vulgaris);85
7.2.1.3;17.3 Case 3 (Segmental Vitiligo: Mini Punch Grafts vs. Microskin Grafts);88
7.2.1.4;17.4 Case 4 (Acrofacial Vitiligo);90
7.3;Chapter 18;94
7.3.1;Microskin Grafting by Spraying Method in Extensive Vitiligo Management;94
7.3.1.1;18.1 Case 1(Stable Segmental Vitiligo-Cheek);94
7.3.1.2;18.2 Case 2 (Vitiligo Vulgaris);95
7.3.1.2.1;18.2.1 First Microskin Graft Operation;96
7.3.1.2.2;18.2.2 Second Microskin Graft Operation Performed in the Same Patient After 63 Days;100
7.3.1.2.3;18.2.3 Third Microskin Graft Operation done on fifth day of second operation;101
7.3.1.3;18.3 Case 3 (Extensive Vitiligo);108
8;Part IV: Surgical Outcomes;117
8.1;Chapter 19;118
8.1.1;Complications Involved in Various Surgical Techniques;118
8.1.1.1;19.1 Recipient Area Complications;118
8.1.1.2;19.2 Donor Area Complications;121
8.2;Chapter 20;124
8.2.1;Outcome of Various Techniques of Vitiligo Surgery;124
8.2.1.1;20.1 Surgical Outcome and Benefits of Microskin Grafting;125
8.2.1.1.1;20.1.1 What Need to Be Followed in Microskin Grafting?;125
8.2.1.1.2;20.1.2 What are the Benefits of Microskin Grafting?;126
8.2.1.1.3;20.1.3 Donor to Recipient Area Expansion Ratio;127
8.2.1.1.4;20.1.4 Caution!;127
8.2.1.1.5;References;129
9;Appendix 1;130
10;Index;132