Surgical treatment may be performed if topical steroids or PUVA are not treated. The surgical treatment of vitiligo was first carried out in
Surgical treatment may be performed if topical steroids or PUVA are not treated. The surgical treatment of vitiligo was first carried out in the early 1950s and was applied to patients with segmental or localized vitiligo in stable phase (i.e., within 4 to 6 months of skin lesions without extension).
1, autologous epidermal transplantation
The method is effective, fast, easy to promote, is currently the treatment of stable period of localized or segmental vitiligo curative effect is ideal method. This method is to use the principle of negative pressure suction, the skin of the normal part of the skin layer in the white spot lesions to increase the number of melanocytes in the lesion area. In general the use of porous sucker lesion of vitiligo and skin donor (general abdominal and thigh skin), and 30 ~ 60kPa suction blister, the dermis and epidermis separation. Blisters occurred after removal of topical skin, skin blisters from the donor site on the white tiled skin exposed, compression bandage. 2 weeks after transplantation, the epidermis was alive, that is, the formation of pigment, melanin deepened after 4 weeks of expansion, from 3 to 6 months to maximize the amount of pigment. Some special parts of the white spots, such as the nose, mouth and forehead, joints and other flat parts, it is difficult to absorb the sucker, grinding operation, the skin abrasion, then the above can be normal epidermal grafting. Hann and so on 100 cases of patients with stable refractory vitiligo patients with autologous epidermal transplantation has achieved good results, and that before and after transplantation with photochemical therapy (PUVA) treatment of donor site can improve the efficacy. Many domestic hospitals have carried out this therapy, the success rate has reached 80% ~ 90% or more than 90%, the author uses the method of autologous epidermal grafting for the treatment of 50 cases of stable vitiligo patients with effective rate of 83%, but the eyebrow and jaw have poor hair position effect.
Micro skin graft for the treatment of stable type segmental and localized vitiligo, namely normal skin transplantation in 1 rows ~ 2mm size of the skin leukoplakia in the region, donor areas generally choose the lumbosacral region and the survival rate of the transplanted flap after 3 ~ 6 months can increase the pigment to the original 25 times the. The operation time is short, but may cause uneven skin treatment. Suction blister transplantation refers to the skin under the negative pressure of -200mmHg, 2 to 3 hours after the separation of the epidermis and dermis, blister formation. Blister wall contains the active melanocytes, the blister skin grafting epidermis with liquid nitrogen freezing or dermabrasion wound bandage, white spots, usually about 7 days of healing, pigment in 3 ~ 6 months and gradually extended. The advantage of this method is that it does not hurt the dermis, leaving no scars, but the equipment condition is higher.
2, autologous epidermal cell suspension transplantation
The method eliminates the tedious steps of cell culture, has a large area of transplantation, and is safe. Non success of melanocyte transplantation in the treatment of vitiligo culture Gauthier in 1992 with keratinocytes, domestic Xu Aie treated 24 patients with stable vitiligo patients with this method, including 23 cases of postoperative recovery of the pigment, a maximum area of 110 cm2 transplantation. Operation method for patients with normal skin (thin piece to punctate hemorrhage is appropriate), digested with trypsin, which contained keratinocyte suspension cells and melanocytes of single cell. In the white spots before transplantation, blister, blister fluid will suck in each blister injected cell suspension. 3 to 4 weeks after transplantation, local punctate pigmentation, fuses gradually expand outward, pigment spots 2 ~ 3 months can form 0.5 to 1 times in the blister area, 1 ~ 2 times of transplantation repigmentation can reach more than 90%.
3, autologous melanocyte transplantation
This method is on the melanocytes were cultured cells, the greater the amount of the better curative effect, and only take a skin to do more at transplantation, the key method is to develop melanoma cells in vitro, and can be divided into melanocytes cultured epidermal melanocytes and pure culture. In 1982, American scholar Eisinger with TPA (12 - 0 - fourteen - 13 - phorbol acetate) and cultured melanocytes cultured successfully with cholera toxin in 5% fetal bovine serum, melanocyte transplantation in the treatment of vitiligo in 1987 Lerner first successful application training. In general the patient's own normal abdominal and thigh skin after treatment and a series of cell culture, the melanoma cell suspension was injected into the skin lesions by suction blister blister fluid pumping to blister, dressing for 2 weeks; also can be used in grinding method, the white parts of the skin off, the melanin cell suspension evenly on the wound. Xu Xiaoke, who took the lead in the development of melanocytes in the epidermis and melanocytes culture method for the treatment of vitiligo, were satisfied with the curative effect, 3 months after the average recovery rate of pigment reached 80% ~ 90%. However, the operation cycle is long, the cost is expensive, the technology and equipment requirements are high, it is difficult to promote. Moreover, the essential component of TPA is a kind of cell inducer, and the safety of melanocyte transplantation in medium containing TPA needs further study.
4, allogeneic melanocyte transplantation
The method is basically the same as that of the former method, the difference is that the former donor is the patient's own, and the latter is the other healthy skin. The method was pioneered by the Department of Dermatology, Huashan hospital, Zheng Zhizhong has been treated for more than and 30 patients, the efficiency of more than 95%. Allogenic melanocytes transplantation than autologous melanocyte transplantation and a step forward, because studies have shown that patients with vitiligo its "normal" skin histological abnormalities are also, and healthy people using allogenic melanocytes transplantation, it is possible to solve the problem. However, because of this method, the problem of rejection has not been completely solved.
5, hair transplantation
Hair transplantation method is based on the hair follicle around the hair follicle in particular, the principle of 1/3 active melanocytes. After taking the patient's occipital scalp, and cut into many pieces of hair, and then use a hair transplant device to transplant the hair to the skin area, set up a week. For the recipient area, the 1/3 can be removed before the hair follicle implantation, and the hair follicle is transplanted into the hair follicle. Na was used to treat 21 patients with vitiligo. Among them, 15 cases had the regeneration of pigment around the transplanted area within 2 to 8 weeks, and expanded to a diameter of about 2 ~ 10 mm. However, the effect of the treatment is poor, and there are time-consuming operation and the appearance of cobblestone appearance.
6, skin grinding
Skin grinding can stimulate the proliferation and differentiation of melanocytes at the white spot, if combined with 5 fluorouracil cream, can improve the efficacy. The method is to rub skin slight petechial hemorrhage after daily with 5%5 FU cream dressing, 7 ~ 10 days after the cessation of topical epidermal regeneration after 1 weeks, 2 weeks after the start of pigmentation, reported at home and abroad recovered up to 18.3% ~ 64%, 83.3% ~ 89.2% efficiency.
Department of Dermatology Wuhan Union Hospital Chen Siyuan
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