05. Re-pigmentation of stable vitiligo of the face by means of timedsurgical de-epithelialisation and autologous grafts of cultivated epidermis
KEYWORDS: vitiligo, piebaldism, timedsurgery, de-epithelialisation, cultivated autologous keratinocytes and melanocytes.
Areas of stable vitiligo and piebaldism can easily be repigmented by means of timedsurgical de-epithelialisation followed by the grafting of autologous keratinocytes and melanocytes cultivated from a 1 cm² fragment of skin taken from a normopigmented area about 20 days earlier. Once local anaesthesia with mepivacaine has been carried out, de-epithelialisation is started. De-epithelialisation is carried out at 1 or 2 Watts by means of the pulsed current specifically designed for de-epithelialisation of the skin. The edge of the corner of an EM 10 Yellow electromaniple® is used for de-epithelialisation. Pulsed timedsurgical de-epithelialisation enables the achromic epidermis to be detached from the dermis, while maintaining the integrity of the papillae and the papillary-capillary plexus.
Histological picture of the epidermis detached from the dermis by means of timedsurgical de-epithelialisation.
The dermis remains intact, thus enabling the keratinocytes and melanocytes to take root perfectly.
The programme data used for de-epithelialisation are as follows: Direct Pulsed etc. The edge of the corner of the EM 10 Yellow electromaniple skims over the skin in small circular movements. If the skin is particularly dry, it needs to be moistened with physiological solution. The electrode is cleaned frequently during the procedure. On completion of the first phase of the procedure, the epidermis is removed by means of the same non-activated electrode. The epidermis must detach easily. Any residual points of adhesion are re-treated with the specific pulsed current. Once the epidermis has been removed, the dermis is washed and the graft of keratinocytes and melanocytes cultivated from the fragment of integral skin is applied. In applying the graft, care must be taken to avoid trapping bubbles of air. A non-compressive medication is then applied; this will be removed after eight days. Six months later, the achromic area will be seen to have been perfectly re-pigmented.
Result of the graft of cultivated autologous keratinocytes and melanocytes following timedsurgical de-epithelialisation.
Capurro S.; Pellegrini G. (2002) Re-pigmentation of stable vitiligo of the face by means of timedsurgical de-epithelialisation and autologous grafts of cultivated epidermis. CRPUB Medical Video Journal. Timedsurgery section. http://www.crpub.org
This procedure replaces the achromic epidermis with a cultivated epidermis endowed with melanocytes. What is the advantage of this procedure?
Timedsurgical de-epithelialisation maintains the integrity of the dermis. If the dermis is integral, the graft will take root perfectly. After this procedure, the re-pigmented skin will look exactly like the patient's normal skin, without any surgical or cicatricial artefacts.
Can this technique be used in all cases of vitiligo?
No, only in stable vitiligo and piebaldism.
Can scars be re-pigmented, too?
Yes. We have performed this procedure successfully on numerous large achromic scars.
Can this technique be used on small achromic scars?
No, it is too costly. If the scars are small, we only use a Timed micro-vaporisation of one three-hundredth or two three-hundredths of a second at a power of 50 Watts. Once the achromic epidermis over the scar and at the edges has been removed, the scar will be re-epithelialised from the surrounding epidermis of the healthy skin, and the area will take on a normal pigmentation.
Which achromic lesions can be treated by means of timedsurgical micro-vaporisation?
We treat small iatrogenic achromic lesions and those caused by the sun. We also use timedsurgical micro-vaporisation to treat achromic surgical scars on the face or body, such as those due to elastic face-lifting or those of the areola.
For which other procedures can pulsed timedsurgical de-epithelialisation be used?
It can be used to eliminate deep wrinkles of the lip and “crow’s feet”, to de-pigment dermal-epidermal patches, and to treat recurrent plane warts and epidermolysis bullosa. In this last procedure, the pathological epidermis is replaced with an epidermis modified by means of genetic engineering.
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