Vitiligo is a common and frequent pigmented skin disease, manifesting as local or generalized pigment loss. It is a common pigmented skin disease that manifests as localized or generalized pigment loss. Although it does not affect the normal physiological activities of the patient, it affects the beauty and is easy to diagnose and difficult to treat. The disease can affect all races and occurs all over the world, the incidence is estimated at about 1%, there is no significant difference in the incidence between men and women, it can occur at any age, generally the incidence is lower in people with light skin tone and higher in people with darker skin tone. The following talk about surgical treatment: Guangdong Provincial Dermatology Hospital, Department of Dermatology He Renliang 1, surgical excision: for patients with small areas, especially hairy areas, who are ineffective with regular medication and whose condition is stable and has no tendency to develop, can be excised and sutured directly by cosmetic surgery methods or by applying local flap transfer.
2.Simple skin grinding: It is suitable for white spots with small area, generally should be less than 1~2cm2 of stable lesions. With the help of epidermal trauma healing and repair, melanocytes proliferate and migrate in order to repair the melanin-deprived skin.
3, autologous skin transplantation for vitiligo: (1) full-thickness skin graft: poor appearance, large color difference and obvious scar; (2) medium-thickness skin graft: slightly improved compared with full-thickness skin graft; (3) epidermal skin graft: beautiful appearance, small color difference and inconspicuous scar.
4, autologous epidermal transplantation for vitiligo (1) the acquisition of autologous epidermis 1) the selection of the donor area: hidden parts, local flatter, and less color difference with the recipient area, generally more abdominal wall, buttocks, inner (outer) thighs.
The method of taking the skin: a. Roller shaft type skin removal knife to take the skin; b. Drum type skin removal knife to take the skin; c. Electric skin removal knife to take the skin; d. Skin removal knife to take the skin with bare hands; e. Negative pressure suction herpes to take the skin 5, clinical more commonly used treatment vitiligo epidermis transplantation method (1) negative pressure suction herpes method for vitiligo: 1) negative pressure suction herpes to get the epidermis: application vitiligo treatment instrument, it is equipped with different shapes of suction cups for different parts of the body. This method is easy to operate, low technical requirements, more suitable for dermatologists to complete. The blistering time is 30-50 min, and the operation should identify the front and back side of the skin taken.
(2) Treatment of the affected area (white spot area): The epidermis of the white spot area can be removed by suction and cut off and discarded, and the normal epidermis can be transplanted on it. Skin grinding method can also be used to remove the white spot, and then transplant the epidermis on it.
The postoperative wound is wrapped with petroleum jelly for 7-10 days to heal until the jelly falls off on its own.
Disadvantages: The one-time treatment area is limited, and larger areas are often treated several times. Post-operative spotted uneven pigmentation may occur.
(2) roller skin removal, drum skin removal, electric skin removal treatment vitiligo The mechanism of this method is also epidermal transplantation treatment vitiligo, but the method of skin removal is different.
Advantages: suitable for large or extra large area lesions, not limited by the transplant area, one-time treatment can reach several hundred square centimeters. The most important thing is that you can get a good idea of what you are looking for.
6, the indications of epidermal transplantation: mainly applicable to the stationary stage or segmental vitiligo, the number of skin lesions is not much, pay attention to the beauty. Scar body and homomorphic reaction are contraindicated.
7, other methods (1) autologous single hair transplantation (2) autologous microtransplantation (3) autologous black cell transplantation ① cultured epidermal slice transplantation: take a small piece of the patient’s own healthy skin, isolate the epidermis and obtain epidermal cell suspension after placing it in the culture medium with the help of a carrier membrane to obtain epidermal slice with melanocytes, and place it flat on the bare surface of the lesion to wrap it.
②Epidermal cell suspension transplantation: The patient’s own healthy epidermis is peeled and made into epidermal cell suspension, and then the epidermal cell suspension is inoculated into the blisters after blistering, or the skin at the white spots is ground, and then the epidermal suspension is spread and finally bandaged.
③Cultured melanocyte transplantation: The patient’s own healthy epidermis is chipped and made into epidermal cell suspension, then inoculated into a culture bottle for melanocyte culture, and then the in vitro proliferated melanocyte suspension is transplanted to the grinding surface. This method has laboratory operation, requires high conditions, long time and is expensive. It is difficult to be popularized clinically, and there are some problems in the culture process, which need to be further studied.
(4) Allogeneic epidermal transplantation: There are problems of rejection and it is in the research stage.
(5) Tattooing: treatment by artificial pigment implantation tattoo, this is passive treatment, in vitiligo treatment, non-allergenic iron oxide with pigment is implanted at the white spot by physical method, which can play a long-term covering effect on the white spot.
(6) Depigmentation therapy: When the area of skin lesions is greater than 50%, all the above therapies are ineffective, or large area of vitiligo on the face residual small area of normal skin color, the patient gave up other treatments, can consider choosing depigmentation therapy 20% hydroquinone monobenzyl ether ointment twice a day gradually depigmentation. After depigmentation therapy, regular depigmentation therapy is still needed once every 3 to 4 months. 4-p-methoxyphenol and Q-switched ruby laser depigmentation are also available.
No matter what kind of surgical treatment, all need the assistance and maintenance of drugs.
8.Laser treatment 9.Fire needle treatment