Clinical significance of suction blister transplantation in improving efficacy of ReCell technique in treatment of vitiligo / 中华医学美学美容杂志

Objective:To investigate the clinical significance of suction blister transplantation in improving the efficacy of ReCell technique in the treatment of vitiligo.Methods:Patients were divided into three groups, namely, vitiligo patients without history of suction blister therapy, patients with ineffective suction blister therapy and patients with effective suction blister therapy. There were 30 patients in each group. All patients were treated with standard procedure of ReCell technique. The color recovery effect of leukoplakia was observed 3 and 6 months after operation, and the incidence of complications was also observed.Results:The effective rate of color recovery 3 and 6 months after operation were as follow: in patients without history of suction blister group, the effective rate of three months was 53.3%, and that of six months was 63.3%; in patients with ineffective suction blister group, the effective rate was 43.3% in three months and 50.0% in six months, and in patients with effective suction blister group, the effective rate was 76.7% in three months and 90.0% in six months. No obvious complications were observed in the three groups.Conclusions:For the treatment of stable vitiligo with ReCell technique, suction blister method is a simple and effective method for screening patients.

Non-cultured Epidermal Cell Suspension Transplantation Using Suction Blisters to Treat Refractory Vitiligo: A Retrospective Study of 20 Cases / 대한피부과학회지

BACKGROUND: As nonsurgical interventions for vitiligo are not always successful, various surgical modalities have been used in patients with refractory vitiligo. Of these, non-cultured epidermal suspension transplantation (NCES) was recently introduced to treat large recipient sites using cells from small donor tissue. OBJECTIVE: We assessed the effectiveness and safety of NCES as a surgical treatment for patients with refractory vitiligo. METHODS: We retrospectively reviewed 20 cases in 17 patients (11 females; median age 25 years) who underwent NCES from July 2015 through March 2018. Suction blisters (20 mm in diameter) were collected from the patient's inner thigh at a donor-to-recipient area ratio of 1:5. After the addition of 5 mL recombinant trypsin solution to the suction blisters, followed by incubation at 37℃ for 60 min, epidermal cells were manually scraped off the blister surface, and epidermal cell suspension was obtained by centrifugation at 1,500 RPM for 5 min. The suspension was applied to the vitiligo regions after epidermal ablation of those regions. Phototherapy resumed 1 month later. Treatment success was defined as ≥75% repigmentation of the surgical site, and all adverse events were noted. RESULTS: Overall, 85.0% of cases (17/20) exhibited treatment success. Adverse events included hyperpigmentation (20%) and surgical site infection (5%), but the treatment was tolerable in all cases. CONCLUSION: NCES is a reliable surgical option for patients with vitiligo refractory to nonsurgical treatment. Large areas of vitiligo can be treated by NCES, and use of this technique should be encouraged in Korea.

A Case of Refractory Vitiligo Treated with Non-cultured Epidermal Cell Suspension Transplantation Using Suction Blister Method / 대한피부과학회지

Vitiligo is a commonly acquired cutaneous depigmentation disorder that affects 0.5~1% of the population worldwide. While phototherapy is the primary treatment for vitiligo, surgical methods can be used for treating patients who are refractory to conventional treatments. Herein, we present the case of a 14-year-old Korean girl who developed vitiligo after hematopoietic stem cell transplantation for the treatment of acute lymphoblastic leukemia. She had multiple depigmented patches on her lower legs that did not respond to narrow-band ultraviolet B phototherapy for 7 months. The depigmented patches were successfully treated by transplantation of non-cultured epidermal cell suspension from the epidermal roof of the suction blister in the right inner thigh. No adverse event, such as secondary infection or scarring in both the donor and recipient sites, was noted. We recommended that non-cultured epidermal cell suspension transplantation using the suction blister method would be a safe and effective option for the treatment of refractory vitiligo.

Comparison of Repigmentation of Stable Vitiligo via Punch Grafting, Thin-thiersch’s grafting and Suction Blister Grafting

Background: Vitiligo is defined as an acquired melanocytopenia of obscure aetiology and is characterized by circumscribed hypomelanosis and depigmentation of skin and hair which is often progressive. The aim of present study is to compare between 3 surgical modalities i.e. miniature punch grafting, thin split-skin thickness grafting and suction blister grafting and to experiment a novel method according to the site, size and location of the lesion and to study the extent of re-pigmentation after doing these procedures and comparison of the results in patients of stable vitiligo. We also aim to assess the complications and disadvantages of different surgical techniques. Methods: The study was conducted on total 60 vitiligo patients, who were divided into 3 groups of 20 each, in the age group of 15-60 years, attending Dermatology Department of Katihar Medical College in the span of 2 yearsResults. Results are comparable overall but vary considerably according to site of lesions. Punch grafting is very good for mobile areas like elbow, ankle and other joints;  Thin – thiersch’s skin grafting gives better results for flat areas like trunk, thigh, arms and face while Suction blister grafting gives satisfactory results for lips vitiligo and also over small, oval lesions over flat sites. Conclusions: Thus, it can be finally concluded from this study that the surgical modality for treating a case of vitiligo cannot be generalized. Every patient should be evaluated individually according to anatomical site involved, size and shape of lesion, time required to achieve pigmentation, infrastructure available and patient’s preferences.

Treatment of Discoid Lupus Erythematosus with Autologous Suction Blister Graft / 대한피부과학회지

Discoid lupus erythematosus (DLE) commonly develops on the sun-exposed area such as the bridge of the nose, malar areas, lower lip and ears. Typically lesions have well-defined discoid erythematous patches with adherent scales, horny plugs, telangiectasia, hypopigmentation and atrophy. Topical, systemic and intralesional injection of steroid and antimalarial drugs have been used. However, the most important treatments in DLE are avoidance of sunlight exposure and daily use of high SPF sunscreen. We treated two DLE patients with autologous suction blister graft (ASBG) which has been widely used for treatment of vitiligo. In general, grafted sites tend to be hyperpigmented after ASBG, so we adopted this characteristic to the treatment of DLE for the purpose of achieving natural sun protection. After one month of ASBG, not only increased pigmentation but also improved skin texture of the lesion was observed. We thought ASBG provided the biologically protective barrier to sunlight and somewhat improvement of DLE lesion. Therefore, ASBG could be regarded as one of the options in the therapeutic modalities of DLE.

Manufacture and application of skin suction blister apparatus / 医疗卫生装备

Objective To manufacture the skin suction blister apparatus and observe the curative effect of autologous epidermal grafting in treating vitiligo.Methods According to the theory of local skin suction blister: local skin suction blister is decided by the two facts of the negative pressure and temperature,the skin suction blister apparatus was manufactured based on feedback principle,and was applied to autologous epidermal grafting for treating vitiligo.Results The performance of skin suction blister apparatus was stable,the operation was relative simple,and the total survival grade of autologous epidermal grafting was 98.01%.Conclusion The skin suction blister apparatus is simple to operate and its curative effect is excellent for clinical application.

A Case of Piebaldism Treated by Combination Therapy with Suction Blister Epidermal Graft and the Alexandrite Laser / 대한피부과학회지

Piebaldism is a rare, autosomal dominant inherited disorder, characterized by inborn hypopigmented skin and hair. It is characterized by stable leukoderma with white forelock and vitiligo like amelanotic macules usually containing hyperpigmented macules at the periphery. As the leukodermic lesions in piebaldism are unresponsive to any form of topical or systemic medical treatment, several methods for autologous transplantation of melanocytes and epidermal transplantation methods have been developed and there are no specific treatment methods for hyperpigmented patch in piebaldism. A 12-year-old female had piebaldism from birth. Suction blister epidermal graft was tried at hypopigmented patches on the posterior aspects of both lower legs and the Q-switched Alexandrite laser was used at the site of the hyperpigmented patches. Combination therapy with suction blister epidermal graft and a Q-switched Alexandrite laser on piebaldism may be effective method.

The Ivory Colored Hypopigmentation After Autologous Suction Blister Grafts in Vitiligo Lesion May be Caused by the Pretreated Deep Freeze

BACKGROUND: Ivory colored hypopigmentation has been frequently observed in morphea and lichen sclerosus et atrophicus, and also seen after phenol peels, dermabrasion, cryosurgery and post-laser resurfacing. OBJECTIVE: This study was undertaken to investigate the cause of hypopigmentation following autologous suction blister graft (ASBG) in vitiligo patients. METHODS: The ivory lesion and contralateral normal skin were collected by punch biopsies. And the tissues were stained with hematoxylin-eosin, Fontana-Masson, Masson's trichrome, Verhoeff-van Gieson, and S-100 protein to compare the differences between two specimens. RESULTS: H-E and Masson's Trichrome stains showed that compacted hyalinized sclerotic collagens and collapsed, small sized capillaries in the upper dermis were definite in the hypopigmented lesion, whereas norma1 control sites were unremarkable. Elastic fibers were markedly decreased or fragmented in upper dermis of the hypopigmented lesion. Fontanna-Masson stain identified that the lesional epidermis was more hyperpigmented rather than hypopigmented. S-100 stain showed no differences between hypopigmented and contro1 sites. CONCLUSION: The results suggest that the ivory colored hypopigmentation is not caused by the failure of procedure, but by scar formation due to deep freeze; therefore, this kind of complication may be prevented by carefully performing the cryotherapy.

Treatment of Chronic Ulcer with Epidermal Autograft / 대한피부과학회지

BACKGROUND: Reepithelialization is necessary to protect a wound from the surrounding harmful environment. Keratinocytes synthesize basement membrane proteins and various cytokines contribute to wound healing. OBJECTIVE: This study was done to evaluate the effect of autograft using suction blistered epidermis on the treatment of chronic ulcers. METHODS: Fourteen patients with chronic ulcers were treated using autologous epidermal grafts. Grafted epidermis was fixed to recipient sites with TegadermTM for a week. RESULTS: The treatment with epideraml autograft was effective in 9 cases. The results were affected not by underlying systemic diseases but by lesional sites and local factors. The lesions on the feet brought the poorest results. The results also depended on the immobilization of grafted sites. CONCLUSION: Epidermal autograft is a useful method of treatment in some kinds of chronic ulcers.

Comparison of the Concentrations of 8-MOP in both Plasma and Suction Blister Fluid after Oral Ingestion

BACKGROUND: The value of plasma concentration of 8-Methoxypsoralen(8-MOP) in the supervision of photochemotherapy has been recognized. However, plasma levels of 8-MOP were not proportionate to the degree of PUVA induced erythema and couldn't alone predict the degree of PUVA induced erythemal reaction. We made a speculation that the degree of PUVA induced erythema might correlate better with skin tissue levels of 8-MOP than plasma levels. Suction blister fluid(SBF) has been known to represent tissue fluid in the skin. So we per-formed a study of comparison of 8-MOP concentrations in both plasma and SBF. OBJECTIVE: Our purpose was to evaluate the correlation of the concentrations of 8-MOP in plasma and SBF 2 hours after oral administration of 0.6 mg/kg of 8-MOP. METHODS: Twenty six patients, aged between 16 and 50 years, undergoing suction blister surgery for vitiligo treatment, participated in this open study. Single oral doses of 0.6 mg/kg of body weight of 8-MOP were taken. Blood samples(5ml) and SBF(2ml) were collected at 2 hours after the drug administration, and 8-MOP concentration in plasma and SBF were quantitated by reverse phase high-performance liquid chromatography (HPLC). RESULTS: 8-MOP concentrations in plasma and SBF ranged from 18 to 545 ng/ml and 8 to 179 ng/ml, respectively. On the analysis of linear regression, a close-relation could not be observed between two SBF levels; measured and predicted values which were calculated from measured plasma and SBF concentrations (r²=0.583, P < 0.001). CONCLUSION: The correlation of plasma and SBF concentrations of 8-MOP is weak. So, SBF levels of psoralen are recommended for the study of PUVA erythemal reactions.

Autologous Epidermal Sheet Grafts Using a Suction Blister in Two Cases with Skin Ulcers / 대한피부과학회지

Conventional skin grafts, cultured allogenic epidermal grafts, and autologous epidermal sheet grafts have been used to cover skin ulcers. We report here two cases of autologous epidermal sheet grafts after suction blistering was performed. The first patient was a 25-year-old adolescent who had multiple ulcers on the face after chemical peeling at a skin care center. The second case was a 21-year-old woman who had a 4x4 cm ulcer on the right shin area thought to be pyoderma gangrenosum. We treated these skin ulcers successfully without recurrence using autologous epidermal sheet grafts.

A Case of Chemical Burn Wound Treated by Suction Blistered Epidermal Grafting

The patient was a 34-year-old male who had the dorsum of his right foot burned with strong alkali. Subsequently, the wound changed to an ulcer 3 days after the accident, and it was resistant to conventional treatment. After seventeen days of a granulation tissue-forming period, we applied a suction blistered epidermal graft using an intrinsic heating system we had devised. Suction blistered epidermal grafting is a less painful method with minimal scarring that is applicable to various skin diseases and researches. However, currently used techniques require patients to be immobile for some time and it makes physicians and patients feel uneasy and uncomfortable. The time needed for the suction blister formation is dependent on many factors. Among them, the temperature and the suction pressure are the important factors that can be modified easily. So, we devised a suction device having the capability to heat itself and used a suction machine with a pressure meter. We applied this to the above patient. We present a case of a chemical burn wound treated with suction blistered epidermal grafting.

Autologous Epidermal Graft Using Suction Blister in Leg Ulcers

Regardless of the any cause leg ulcers are painful and inconvenient to patients and present clinical and economic problems due to their chronicity. Conventional skin grafts, cultured allogenic epidermis, and cultured autologous epidermis have been used for the treatment of leg ulcers. In a twenty-year-old woman with leg ulcers, autologous pure epidermal sheets were obtained from the lower chest by means of suction blisters and grafted to the leg ulcers. All lesions were healed completely in 20 days after grafting. The donor sites showed slight postinflammatory hyperpigmentations without scars. The autologous epidermal graft using suction blisters appears to be a useful method for the treatment of leg ulcers, with no immunologic rejection, no need for cultivation and anesthesia, no desiccation, and no scars on the donor sites.

Maximal Tension of Human Epidermis Prepared from Suction Blisters

BACKGROUND: Epidermis is directly exposed to various external stimuli and protects internal structures. Most studies about skin tension focused on the dermis, and epidermal tension has not been able to attract interest because dermis much thicker than epidermis and dermal collagen fibers play a predominant role in the skin tension. However, circumstances which involve only the epidermis are often shown, and thus it is necessary to study the mechanical property of the epidermis. OBJECTIVE: The purpose of this study is to quantify the role of the epidermis as a mechanical barrier. METHODS: Human epidermal sheets were obtained from suction blisters in 14 patients with vitiligo during epidermal grafting. Maximal tension, that is the power required to break the epidermal sheets, was measured by tensiometer. RESULTS: The maximal tension of the epidermis ranged from 40.0 g/cm² to 84.5g/cm² with a mean values of 56.1g/cm² and did not differ significantly according to the age or anatomical sites. CONCLUSION: The barrier function of epidermis is important and the results are expected to be used as the basic information for other studies about the mechanical property of the epidermis. In addition, this will be important data in developing an artificial skin whose mechanical property is similar to that of the human skin.

Autologous Suction Blister Grafting for the Treatment of Vitiligo

BACKGROUND: There are many therapeutic options for vitiligo such as phototherapy, steroids, transplantation of blister tops or minigrafts, and the application of cultured melanocytes. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of autologous suction blister grafting for the treatment of vitiligo. METHODS: Blisters were made by suction at 450 mm Hg from the buttock or upper thigh as donor sites. The epidermal sheet was then grafted to the recipient site. Two weeks after grafting, topical PUVA, or topical corticosteroid application were recommanded. RESULTS: The restoration of pigment including partial recovery was seen in 130 of 144 patients with vitiligo; grade 0 in 14 patinets(10%); grade 1 in 21(36%); grade 2 in 22(27%); grade 3 in 28(27%). In type B vitiligo, repigmentation was seen in 71 of the 74 patients; grade 0 in 3 patinets; grade 1 in 21; grade 2 in 22; grade 3 in 28. However, repigment in type A was seen in 58 of the 70 patients; grade 0 in 11 patients; grade 1 in 33; grade 2 in 16; grade 3 in 10. The repigmentation rate was related to age in both type A and B. The rate was higher in the "less than 31-year-old" group than in the "over 31-years-old" group. (p<0.01, Mann-Whitney test). CONCLUSION: The author experienced different repigmentation according to the types of vitiligo and patient age, that is,it was more effective in type B vitiligo than type A, and the younger the age of the patient, the better the results.

The effects of autograft using suction blistered epidermis in the treatment ofvitiligo: the follow-up study of 22 patients / 대한피부과학회지

Autograft using suction hlistered epidermis is one of the surgical therapeutic mod- alities of vitiligo, and has been successfully used by several authors. The maintenance of grafting pigment is belieued to be more important than repigmentation itself. To examine the maintenance of pigment, 22 vitiligo patients were treated by autograft using suction blistered epidermis and followed for 16.8 months. Repigmentation developed in 20 patients, Two patients were lost to follow up. Out of 20 patients, grafting pigment was maintained in 17 patients(85% ) and disappeared in three patients(15% ). By clinical subtype, the rates of maintenance were 100% in segmental type, 80% in localized type and 66% in generalized type. The best results were observed in a head and neck location and the worst rates and maintenance were in the hand. However, these differences were not statistically significant. likewise, age and sex were not factors in maintenance and repigrnentation. Based on this study, autograft using suction blistered epidermis appears to be a good therapeutic modality for stable vitiligo, particularly segmental vitiligo.