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Proc Derm 2020 > Vitiligo surgery > Flashcards

Vitiligo surgery Flashcards

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Dermatology Board Prep flashcards
1
Q

The absence of progression of disease for a period of 1 year is generally regarded as an optimum period for stable disease.

A

T

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2
Q

Thin split-thickness skin or suction blisters are the most effective and safest techniques for the treatment of vitiligo.

A

T

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3
Q

Minigrating is the easiest technique for treating vitiligo and has a low rate of adverse effects.

A

F Highest rate of adverse effects.

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4
Q

Lips, nipples, genitals and acral areas of vitiligo respond best to medical therapy.

A

F These areas are particularly resistance to medical therapy.

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5
Q

Surgery is indicated in vitiligo when medical treatment is unsatisfactory.

A

T

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6
Q

Vitiligo lesions that respond poorly to medical therapy include: all non-hairy areas.

A

T

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7
Q

Vitiligo lesions that respond poorly to medical therapy include: non-mucosal areas.

A

F Mucosal areas.

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8
Q

Vitiligo lesions that respond poorly to medical therapy include: non-bony areas.

A

F Bony areas.

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9
Q

Vitiligo lesions that respond well to medical therapy include:
Long-standing lesions.

A

F Responds poorly.

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10
Q

Vitiligo lesions that respond poorly to medical therapy include: lesions with leukotrichia.

A

T

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11
Q

Elderly patients and patients with segmental vitiligo respond inadequately to medical therapy.

A

T

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12
Q

Surgical treatment of vitiligo is advocated in stationary, stable and resistant cases, after failure of proper medical management.

A

T

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13
Q

Surgical treatment of vitiligo is capable of stopping the progression of the disease.

A

F It only provides pigmentation.

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14
Q

The basic principle of vitiligo surgery is transplantation of autologous melanocytes from unaffected pigmented skin to lesional skin.
.

A

T

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15
Q

The outcome of surgical treatment of vitiligo is good in stable, localised disease, and poor in unstable vitiligo, extensive disease and acral lesions

A

T

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16
Q

A test graft may be considered whenever there is doubt about vitiligo disease stability.

A

T

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17
Q

It is easy to predict the stability of disease progression of vitiligo in children.

A

F

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18
Q

After surgical treatment of vitiligo, complete pigmentation is seen.

A

F Incomplete, particularly at edges.

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19
Q

Well-defined and hyperpigmented borders of the vitiligo lesions indicate stable disease.

A

T Ill-defined borders = unstable.

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20
Q

Presence of follicular or marginal repigmentation is an indicator of unstable disease.

A

F Stable disease.

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21
Q

The entire donor area needs to be infiltrated with local anaesthesia prior to vitiligo surgery.

A

F This can result in surface irregularities causing the graft to be of uneven thickeness.

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22
Q

Minigraft punching involves harvesting small 1.5-2mm punch grafts from the pigmented donor skin and directly transplanting them on the vitiliginous recipient sites.

A

F 1.2 or 1.5mm

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23
Q

The typical donor site for minipunch grafting is an area of normal skin in close proximity to the recipient site.

A

F Upper lateral thigh or gluteal area.

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24
Q

At the recipient site for minipunch grafting, the punched out chambers are placed at a distance of 5-10mm from each other.

A

T

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25
Q

Recipient chambers should be the same depth as the size of the donor graft.

A

F Slightly deeper so that the graft fits snugly and doesn’t pop out.

26
Q

After minipunch grafting, perigraft repigmentation is expected to start in about 3-4 weeks.

A

T

27
Q

After minipunch grafting, the treated lesion is expected to be completely repigmented within 3-6 months, depending on the location of the treated area.

A

T

28
Q

After minipunch grafting, phototherapy should be started immediately.

A

F Start anytime after 1 week.

29
Q

With minipunch grafting, a 1mm donor graft size can repigment an area 25 times larger than the graft itself.

A

T

30
Q

With minipunch grafting and post-op nbUVB, an area 56 times the graft area may be repigmented.

A

T

31
Q

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.

A

T

32
Q

There are generally no complications seen after minipunch grafting at the donor site.

A

F Can get scarring, keloid/hypertrophic scars, koebnerisation, spread of disease.

33
Q

Polka-dot appearance is the most common complication after minipunch grafting.

A

F Cobblestoning.

34
Q

Cobblestoning after minipunch grafting tends to be permanent.

A

F Improves with time.

35
Q

Minipunch grafting on the face and lips should be performed with smaller punches (1.2 or 1mm).

A

T

36
Q

Suction blister epidermal grafting involves obtaining epidermal grafts from the donor site using prolonged suction – these are then transplanted over denuded vitiliginous areas.

A

T

37
Q

Prolonged suction causes a column of negative pressure, resulting in a split at the dermoepidermal junction and blister formation

A

T

38
Q

The donor site for suction blister epidermal grafting is typically either the upper lateral thigh or gluteal area.

A

F Medial upper arm, flexor forearm or thigh.

39
Q

Anaesthesia is required at the donor site for suction blister epidermal grafting.

A

F

40
Q

Prolonged suction in suction blister epidermal grafting causes a split at the dermoepidermal junction and blister formation.

A

T

41
Q

In suction blister epidermal grafting, negative pressure of about 300-400mmHg is used.

A

T

42
Q

In suction blister epidermal grafting, suction is maintained for 20 minutes.

A

F Maintained until single blister of sufficient size is formed.

43
Q

In suction blister epidermal grafting, the recipient site can be denuded with dermabrasion, Er:YAG laser or CO2 laser.

A

T

44
Q

After suction blister epidermal grafting, pigment spread takes place gradually in 4-6 months covering the entire area.

A

T

45
Q

In suction blister epidermal grafting, the grafts need to be secured with sutures.

A

F Secure with tissue glue at the edges.

46
Q

Possible complications of suction blister epidermal grafting include hyperpigmentation, perigraft halo, incomplete pigmentation and graft slough.

A

T

47
Q

The main advantage of suction blister epidermal grafting is that a thin graft yields excellent cosmetic results with no scarring at the donor site.

A

T

48
Q

Suction blister epidermal grafting is not time consuming.

A

F Can take about 1.5-2.5hrs to form blisters.

49
Q

Suction blister epidermal grafting can be used only to treat small areas at a time.

A

T

50
Q

Targeted phototherapy, 308nm excimer laser and IPL can be used to treated vitiligo.

A

T

51
Q

The most common causes of failure of graft uptake are inadequate immobilisation of the graft, haematoma formation under the graft and secondary infection.

A

T

52
Q

It is impossible to avoid perigraft halo or achromic fissures of depigmented skin between grafts.

A

F Can extend SSGs 1-2 mm beyond vitiliginous skin.

53
Q

Minipunch grafting should not be used in acral areas.

A

F This is one of its indications.

54
Q

Minipunch grafting has a higher success rate than thin SSG.

A

F SSG 78-91% vs minimpunch 68-82%.

55
Q

Suction blister grafting is suitable for treating vitiligo of the lips.

A

T

56
Q

Thin split-thickness skin grafting can be used to treat all areas of vitiligo.

A

T

57
Q

Systemic PUVA therapy is routinely required after thin split-thickness skin grafting for the treatment of vitiligo.

A

F

58
Q

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).

A

T

59
Q

Apart from vitiligo, other causes of leukoderma in the genital region include postinflammatory depigmentation due to genital herpes and contact leukoderma due to condoms.

A

T

60
Q

In acral areas, dermbrasion should be superficial prior to grafting.

A

F Deeper to get adequate vascular bed.

61
Q

The excimer laser (308nm) with a fiber-optic delivery system emits coherent, pulsed light of high-power density

A

T

62
Q

The initial dose is 70% of the minimal erythema dose, with dose increments of 40% for every alternate treatment from treatments one to four

A

T

Proc Derm 2020 (50 decks)

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