Vitiligo surgery Flashcards
The absence of progression of disease for a period of 1 year is generally regarded as an optimum period for stable disease.
T
Thin split-thickness skin or suction blisters are the most effective and safest techniques for the treatment of vitiligo.
T
Minigrating is the easiest technique for treating vitiligo and has a low rate of adverse effects.
F Highest rate of adverse effects.
Lips, nipples, genitals and acral areas of vitiligo respond best to medical therapy.
F These areas are particularly resistance to medical therapy.
Surgery is indicated in vitiligo when medical treatment is unsatisfactory.
T
Vitiligo lesions that respond poorly to medical therapy include: all non-hairy areas.
T
Vitiligo lesions that respond poorly to medical therapy include: non-mucosal areas.
F Mucosal areas.
Vitiligo lesions that respond poorly to medical therapy include: non-bony areas.
F Bony areas.
Vitiligo lesions that respond well to medical therapy include:
Long-standing lesions.
F Responds poorly.
Vitiligo lesions that respond poorly to medical therapy include: lesions with leukotrichia.
T
Elderly patients and patients with segmental vitiligo respond inadequately to medical therapy.
T
Surgical treatment of vitiligo is advocated in stationary, stable and resistant cases, after failure of proper medical management.
T
Surgical treatment of vitiligo is capable of stopping the progression of the disease.
F It only provides pigmentation.
The basic principle of vitiligo surgery is transplantation of autologous melanocytes from unaffected pigmented skin to lesional skin.
.
T
The outcome of surgical treatment of vitiligo is good in stable, localised disease, and poor in unstable vitiligo, extensive disease and acral lesions
T
A test graft may be considered whenever there is doubt about vitiligo disease stability.
T
It is easy to predict the stability of disease progression of vitiligo in children.
F
After surgical treatment of vitiligo, complete pigmentation is seen.
F Incomplete, particularly at edges.
Well-defined and hyperpigmented borders of the vitiligo lesions indicate stable disease.
T Ill-defined borders = unstable.
Presence of follicular or marginal repigmentation is an indicator of unstable disease.
F Stable disease.
The entire donor area needs to be infiltrated with local anaesthesia prior to vitiligo surgery.
F This can result in surface irregularities causing the graft to be of uneven thickeness.
Minigraft punching involves harvesting small 1.5-2mm punch grafts from the pigmented donor skin and directly transplanting them on the vitiliginous recipient sites.
F 1.2 or 1.5mm
The typical donor site for minipunch grafting is an area of normal skin in close proximity to the recipient site.
F Upper lateral thigh or gluteal area.
At the recipient site for minipunch grafting, the punched out chambers are placed at a distance of 5-10mm from each other.
T
Recipient chambers should be the same depth as the size of the donor graft.
F Slightly deeper so that the graft fits snugly and doesn’t pop out.
After minipunch grafting, perigraft repigmentation is expected to start in about 3-4 weeks.
T
After minipunch grafting, the treated lesion is expected to be completely repigmented within 3-6 months, depending on the location of the treated area.
T
After minipunch grafting, phototherapy should be started immediately.
F Start anytime after 1 week.
With minipunch grafting, a 1mm donor graft size can repigment an area 25 times larger than the graft itself.
T
With minipunch grafting and post-op nbUVB, an area 56 times the graft area may be repigmented.
T
Complications after minipunch grafting at the recipient site include cobblestone appearance, polka-dot appearance, variegated appearance, colour mismatch, static graft (absence of pigment spread), depigmentation of graft, perigraft halo or achromic fissure, graft dislodgement or rejection, and hypertrophic scar and keloid formation.
T
There are generally no complications seen after minipunch grafting at the donor site.
F Can get scarring, keloid/hypertrophic scars, koebnerisation, spread of disease.
Polka-dot appearance is the most common complication after minipunch grafting.
F Cobblestoning.
Cobblestoning after minipunch grafting tends to be permanent.
F Improves with time.
Minipunch grafting on the face and lips should be performed with smaller punches (1.2 or 1mm).
T
Suction blister epidermal grafting involves obtaining epidermal grafts from the donor site using prolonged suction – these are then transplanted over denuded vitiliginous areas.
T
Prolonged suction causes a column of negative pressure, resulting in a split at the dermoepidermal junction and blister formation
T
The donor site for suction blister epidermal grafting is typically either the upper lateral thigh or gluteal area.
F Medial upper arm, flexor forearm or thigh.
Anaesthesia is required at the donor site for suction blister epidermal grafting.
F
Prolonged suction in suction blister epidermal grafting causes a split at the dermoepidermal junction and blister formation.
T
In suction blister epidermal grafting, negative pressure of about 300-400mmHg is used.
T
In suction blister epidermal grafting, suction is maintained for 20 minutes.
F Maintained until single blister of sufficient size is formed.
In suction blister epidermal grafting, the recipient site can be denuded with dermabrasion, Er:YAG laser or CO2 laser.
T
After suction blister epidermal grafting, pigment spread takes place gradually in 4-6 months covering the entire area.
T
In suction blister epidermal grafting, the grafts need to be secured with sutures.
F Secure with tissue glue at the edges.
Possible complications of suction blister epidermal grafting include hyperpigmentation, perigraft halo, incomplete pigmentation and graft slough.
T
The main advantage of suction blister epidermal grafting is that a thin graft yields excellent cosmetic results with no scarring at the donor site.
T
Suction blister epidermal grafting is not time consuming.
F Can take about 1.5-2.5hrs to form blisters.
Suction blister epidermal grafting can be used only to treat small areas at a time.
T
Targeted phototherapy, 308nm excimer laser and IPL can be used to treated vitiligo.
T
The most common causes of failure of graft uptake are inadequate immobilisation of the graft, haematoma formation under the graft and secondary infection.
T
It is impossible to avoid perigraft halo or achromic fissures of depigmented skin between grafts.
F Can extend SSGs 1-2 mm beyond vitiliginous skin.
Minipunch grafting should not be used in acral areas.
F This is one of its indications.
Minipunch grafting has a higher success rate than thin SSG.
F SSG 78-91% vs minimpunch 68-82%.
Suction blister grafting is suitable for treating vitiligo of the lips.
T
Thin split-thickness skin grafting can be used to treat all areas of vitiligo.
T
Systemic PUVA therapy is routinely required after thin split-thickness skin grafting for the treatment of vitiligo.
F
In the eyebrows and beard area, the hair should be plucked prior to surgery for the treatment of vitiligo in order to delay regrowth (which can lift up grafts).
T
Apart from vitiligo, other causes of leukoderma in the genital region include postinflammatory depigmentation due to genital herpes and contact leukoderma due to condoms.
T
In acral areas, dermbrasion should be superficial prior to grafting.
F Deeper to get adequate vascular bed.
The excimer laser (308nm) with a fiber-optic delivery system emits coherent, pulsed light of high-power density
T
The initial dose is 70% of the minimal erythema dose, with dose increments of 40% for every alternate treatment from treatments one to four
T
