The basic principle of all surgical methods for vitiligo is the transfer of melanocytes from uninvolved skin into a stable white lesion, where they function as effective epidermal-melanin units. In cellular grafting surgeries for vitiligo, melanocytes and other skin cells are removed from pigmented skin to be ultimately transplanted to white patches. Prior transplantation, the top layer of the skin (where spots are located) is removed by dermabrasion or laser treatment.
Although tissue grafting surgeries for vitiligo such as split-thickness, suction blister, and punch grafts are the mainstay of surgical management for vitiligo, several cellular grafting methods have become popular in recent times.
Each surgical procedure covered under surgeries for vitiligo has its pros and cons. Cellular grafting surgeries manage to deliver better results for larger lesions. However, in comparison to non-cellular techniques, cellular grafting surgical techniques have shown slightly lower success rates. Besides, these surgeries need specialized training and appropriate equipment to impart the best results.
Autologous non-cultured epidermal cell suspensions
This cellular grafting techniqueallows large areas of depigmented skin to be treated in one session, with better color matching. In this procedure, tissues are harvested from normal, pigmented skin before being placed as a suspension on the dermabraded surface of white-skinned areas. Compared to other available skin grafting procedures, autologous non-cultured epidermal cell suspensions offer less risk of scarring during the surgery. Having said that, the surgery is not advised to be performed on children with vitiligo.
Cultured melanocyte suspensions
In this cellular grafting technique for vitiligo, tissues are harvested from the pigmented skin before being incubated with trypsin on the depigmented area. As a precautionary measure, a sample of the patient’s normal pigmented skin is taken before the surgery and sent to a laboratory for special cell culture to grow melanocytes. Once the melanocytes in the culture solution proliferate, they are incubated with trypsin on the depigmented area.
While better color matching is achieved by this technique compared to other surgical methods for vitiligo, it takes a specialized laboratory for culture to achieve the best results through cultured melanocyte suspensions.