MICRO PUCH GRAFTING (MICRO PG) BY USING MOTORIZED POWER PUNCHES AS A TISSUE EXTRACTOR 0.8 MM IN STABLE AND LIP VITILIGO: A NOVEL APPROACH IN STABLE VITILIGO

Vitiligois a common disorder of pigmentation.1 Pathogenetically, vitiligo represents a complex reactionpattern involving multiple etiologic factors, some of them necessarily workingin concert. On-going research is focussing on a better understanding ofpathogenesis and thus searching for better treatment modalities. Treatmentis classified into medical, light-based, surgical, camouflage, anddepigmentation therapy2.

Surgicaltreatment is generally considered when medical/light-based treatment has failedand includes tissue transfer (e.g., punch grafting, partial split-thicknessgrafting, and suction blister grafting) and cellular transfer, which is furtherdivided into cultured and non-cultured techniques.3-5  The basic principle of surgical treatment isto transfer the melanocytes from normal skin to-vitiliginous skin. Non-culturedepidermal cell suspension (NCES) is considered the standard and most effectivesurgical treatment for stable vitiligo and, it along with suction blistergrafting (SBG), has a better outcome than other surgical methods.6

Autologous mini punch grafting is the easiest,effective, and less expensive method of vitiligo surgery. It is indicated inalmost all sites especially in acral vitiligo involving palms, fingers, nipples,and lips.7

Thetechnique of Mini punch grafting (MPG)  hasundergone many modifications over the years to reduce the requirement forequipment and to save time. The timeconsumed in MPG using punches of less than 1.5 mm is more when compared withpunch grafting with 2-3 mm punches, moreover the number of grafts required isalso more with a decrease in punch sizes. With the advent of motorized powerpunches the procedure can be done with more ease in lesser time to harvest moremini grafts (<1.5 mm) in a single session.7

A newer technique of Motorized 0.8-mm micro punchgrafting for refractory vitiligo from a retrospective study of 230 casesconcluded that refractory vitiligowith short procedure times had an excellent outcome. This technique could be arapid and convenient surgical option with acceptable adverse events and ispromising for treating refractory vitiligo on an outpatient basis, particularlyin patients who are unlikely to tolerate prolonged surgery.8

Wealso want to know the efficacy of the same by doing it in the exclusive lipvitiligo and to look at the adverse effects of the 0.8mm micro punchgrafting.