Surgical procedures for Vitiligo

Overview
In cases where conventional vitiligo treatments have not worked, surgery may be an option. Surgical procedures for vitiligo involve transferring skin tissue or pigmentation cells (melanocytes) from an area of healthy skin to depigmented patches caused by vitiligo.^1,2 Surgery is only recommended for adults with stable disease (no new or expanding lesions in previous year).²

What does it involve?
The choice of surgical technique depends on location and extent of vitiligo lesions.² Surgery may also be combined with a short course of corticosteroids or phototherapy to speed repigmentation and improve cosmetic results.

There are two basic approaches - cell grafting and tissue grafting - which involve transferring healthy skin tissue or melanocytes from one part of the body to areas affected by vitiligo.^1,2

In cellular grafting, melanocytes and other healthy skin cells are transplanted to white spots. Cellular grafts have the best results and can cover largest affected skin areas with a smaller-size graft.^1,2 The approach matches the skin more closely, leading to a better cosmetic result.³ The procedure is performed under local anesthesia and takes between two and four hours.²

In preparation for transplant, the top layer of affected skin is removed with dermabrasion or laser treatment.¹ In most cases, a special dressing is applied to the wound, upon which healthy skin is placed and secured with stitches. A dressing to protect the wound is left in place for a week.¹ Within a few months, transplanted skin typically starts making pigment.

Tissue-grafting techniques for treating vitiligo include:

Split thickness skin grafts
Considered the tissue graft of choice for stable, non-responding vitiligo, this procedure has the fastest and highest success rate for skin color and texture match. It involves shaving off thin layers of surface skin from healthy pigmented areas and grafting them onto white spots where skin has been removed.⁴

Suction blister grafting
Using a suction device, blisters are created on healthy pigmented skin, then removed and transplanted to an area of skin without pigmentation. This procedure can cover larger areas of skin and produce more uniform pigmentation with no cobblestoning (bumpy) appearance.^1,3

Punch grafts
Also known as mini-grafting, this is the simplest of all transplant procedures.³ Small plugs of healthy pigmented skin are removed, or “punched out,” from buttocks or thighs and inserted into similarly punched-out-shaped areas that have lost pigment. Adverse effects are highest with this procedure.³

Results
Surgery has proven to be 80 to 95 percent effective when vitiligo is limited to one side of the body (segmental vitiligo) and combined with phototherapy to improve color and texture match.^2,3,5 For best results, it’s recommended only for adults with no new or expanding lesions in previous one to two years. Surgery is not advised for people who scar easily or develop keloids (raised scars).^1,5 Treatment outcomes for genitals, lips, eyelids, and bony areas can vary.¹

Constraints
Adverse effects from vitiligo surgery can include infections, changes in texture of transplanted skin, spotty or imperfect color matching, hyperpigmentation (skin becoming darker than intended), failure to treat white patches, scarring, and graft rejection.^1,2,5 Surgery does not stop vitiligo from progressing.^1,2

External resources

1. Surgical treatment of stable vitiligo. (n.d.). Retrieved December 3, 2019, from https://www.dermnetnz.org/topics/surgical-treatment-of-stable-vitiligo/
   


2. Khunger, N., Kathuria, S., & Ramesh, V. (2009). Tissue grafts in vitiligo surgery - past, present, and future. Indian Journal of Dermatology, 54(2), 150. doi: 10.4103/0019-5154.53196


3. Majid, I. (2013). Grafting in vitiligo: How to get better results and how to avoid complications. Journal of Cutaneous and Aesthetic Surgery, 6(2), 83. doi: 10.4103/0974-2077.112668


4. Sultan, S., Ahmad, Q., & Sameem, F. (2011). Split thickness skin grafting in patients with stable vitiligo. Journal of Cutaneous and Aesthetic Surgery, 4(1), 38. doi: 10.4103/0974-2077.79189


5. Vitiligo Diagnosis and Treatment. (n.d.). Retrieved December 3, 2019, from https://www.aad.org/diseases/a-z/vitiligo-treatment
   
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