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Melanocyte Transplantation

Melanocyte transplantation done at Care Well Medical Centre follows the same guidelines laid out by (SWEDISH PROCEDURE)

Initially the melanocytes were harvested from a small part of normal skin, grown in laboratory & was then transplanted on to the depigmented patch after dermabrasion.

But now a modified procedure is being done where-in the harvested melanocytes are immediately transplanted on to the depigmented patch

Surgical Management Of Vitligo

  • Punch grafting
  • Skin grafting
  • Blister grafting
  • Autologous Cultured Melanocytes Transplant
  • Non Cultured Melanocyte Transplant

Background: Melanocyte Transplantation

Melanocyte transplantation is the latest surgical method for the treatment of stable vitiligo / leucoderma and loss of pigmentation.

Melanocytes are the skin cells which produce melanin In some diseases as Vitligo melanin pigment is destroyed. There can be other causes of this pigment loss also. This can be post burn skin lesions, chemical injury, Peibaldism, nevus depgmentosus or Discoid Lupus Erythmatosus.

In active stage of disease Medical treatment is used. In stable disease Surgical treatment is used.

Till now skin gtafting or Punch grafting was available. But now with new technology we have a breakthrough in treatment of stable vitligo. This is Non cultured Melanocyte Transplantation. It is done in day care procedure and results are quite gratifying for patient.

Who is suitable for Melanocyte Transplantation?

There are two main categories of patients that are most suited to melanocyte transplantation.

a) Indications
  • Post burn white patch
  • DISCOID Lupus Erythematosus
  • Piebaldism
  • Nevus depigmentosus

b) Patients who have had stable vitiligo patches for a period of at least 6 -12 months are good candidates to undergo melanocyte transplantation.

1. OLD White patches should not have increased in size.
2. No new patches should have appeared on other areas.
3. Any injury should heal with normal skin color.

Non Cultured Melanocytes Transplant

The Treatment

Most Advanced Method

Melanocyte transplantation is the most advanced surgical method to treat vitiligo / leucoderma. Large areas can be treated. Repigmentation occurs in about 4 to 6 months and cosmetic results are superior to other surgical methods such as skin grafting and punchgrafting. Difficult areas like bony surface, areola, genitals and knuckles can be treated with excellent results.

Methodolgy : Stable Vitiligo Procedure

  • The Donor area is chosen usually from thighs. Slit thickness graft is taken from these donor area.
  • The split thickness graft is incubated in 10% Trypsin solution for one hour at 37*C.
  • This separates epidermi9s and Dermal layer.
  • The graft is taken and the epidermis is taken in new petri dish and soaked in Anti Trypsin. This neutralizes Trypsin.
  • The Epidermis is shifted to Dulbecco’s medium and sliced into small pieces.
  • The epidermis in Dulbecco’s medium is centrifuged at 1500RPM for 7-10 minutes.
  • A pellet of Melanocyte pigment is formed at base of test tube and is taken for implantation
  • The recipient area is derm abraded and the melanin pigment is transferred on the raw area.
  • The recipient site is covered with Collagen Dressing and foam padding.
  • The dressing is changed after 4-5 days.

Response according to type of vitiligo:

1. Segmental - Best response and most suitable. Success rate 94% ( See below)
2. Focal - Very good response and suitable. Success rate 80%
3. Vulgaris - Responds well on lower extremity, poor response on face. Success rate 75%
4. Acral - Poor response in all areas. Success rate 20%

Success rate of treatment is 94% i.e. 94% of the treated patients develop pigmentation over 65% to 100% of the treated area. A statistical figure of success rate applies to a group of people and not to an individual patient.

Recurrence of vitiligo after treatment:

1. Segmental - Almost no recurrence
2. Focal - Minimal chance of recurrence. It can develop in vulgaris type.
3. Vulgaris - can recur.
4. Acral - Very high rate of recurrence.

How much area can be treated?

In one operative session up to 100 cm2. white patches can be treated depending upon the sites involved. If affected area is large, patient has to undergo multiple sessions.

What happens post-treatment?

The treated site is protected by a dressing for one week. Verbal and written post treatment instructions are provided. Dependant on the site that was treated, no further dressing is required and you will need to follow the instructions that were given. There is usually no bruising or swelling. Some patients may feel minor discomfort at the biopsy and treated site for a few days which can be treated with a mild painkiller if wished. Recovery is remarkably quick. When dressings are removed the treated area appears bright red. Repigmentation is seen only after 4 to 6 weeks in brown skin population and 8 to 12 weeks in Caucasians. It takes about 6 months to achieve maximum results.

Complications & Side Effects

1. Since no medicines are used except post-operative antibiotics, there are no side effects.
2. Scarring and Koebner's phenomenon are rare complications. Trauma of surgery may cause new lesions (Koebner's phenomenon) and is seen in approximately 2% of our patients. Use of oral prednisolone at surgery may prevent Koebner's phenomenon.
3. There may be a hypopigmented ring at the borders of treated and repigmented patches in some patients. Usually this ring disappears automatically or with application of local steroids, or by repeat surgery.
4. Bacterial infection. All patients are given oral antibiotics to prevent chances of infection.

Advantages of Melanocyte Transplantation

  • Cosmetic results far superior than skin grafting or punch grafting
  • Colour Matching is above 80 %
  • Donor area required is only 10 % of recipient area
  • Result comes in 95% cases
  • Minimal complications
  • Early results- in 1-2 months pigmentation is complete
  • Post operative care is minimal.
  • No risk of Malignancy as in Cultured melanocyte Transplantation
  • Day Care procedure