European Academy of Dermatology and Venereology

1746 Levee Road, North Kansas City, MO 64116phone: (800) 247-9951 phone: (816) 221-2442 fax: (816) 221-3995

email: info@elastogel.com • website: www.elastogel.com

17th CongressParis, France17-21 September 2008

SUCTION BLISTER TRANPLANTATIONASSOCIATED WITH NARROW-BANDULTRAVIOLET B FOR SEGMENTAL

VITILIGO TREATMENTPaulo Luzio, Luna Azulay-Abulafia,Ana Cristina Pinto, Patrícia Paludo

Instituto de Dermatologia e Estética do Rio de Janeiro - BrazilVitiligo is an acquired idiopathic disorder involving about 1% of the world population. Segmental vitiligo is a special kind of disease since it usually does not improve with medical treatment and probably is not an immunological disorder. It can be cured with melanocytes transplantation.

Our patient is a male, 58 years old with segmental vitiligo in the forehead. He was treated with tacrolimus and photochemotherapy with PUVA. There was only a slight improvement. Our option for treatment was melanocytes transplantation by suction blister technique.

The donor area was the inner aspect of thigh. With an ink pad and a syringe without the embolus we performed the surgical planning.

Segmental vitiligo in the forehead Ink pad and syringe without the embolus Surgical planning of the donor area

In each site of suction 7 ml of the anesthesia solution was injected before suction. The local anesthesia was prepared with 15ml of 2% lidocaine, 300ml of saline solution and 0.4 ml of epinephrine 1:1000. This is an important step of the technique, because the blister for-mation is very painful and the solution makes the blister formation easier.

Pressure between 250 and 400 mm Hg for 2 to 4 hours is necessary for blister formation. It was performed with a 60 ml disposable syringe connected to a 20 ml disposable syringe through a three-way connector. After two hours of suction the roof of the blisters were ready for transplantation. So we prepared the receptor area by superficial dermabrasion

Injection of 7ml of anesthesia before suction Blisters ready for transplantation Dermabrasion of the receptorPreparing the blisters through suction

pauloluzio@gmail.com patriciapaludo@gmail.com

European Academy of Dermatology and Venereology

17th CongressParis, France17-21 September 2008

1746 Levee Road, North Kansas City, MO 64116phone: (800) 247-9951 phone: (816) 221-2442 fax: (816) 221-3995

email: info@elastogel.com • website: www.elastogel.com

The roof of the blisters were cut with scissors around its periphery and transferred to the recipient site by means of a plastic spatula. After transplantation we wait about 30 minutes to perform the dressing.

Since the dressing must stay at least one week in the receptor and donor areas there is concern about infection. So we’ve been using Elastogel® (Southwest Technologies) to avoid this complication. This dressing is composed of glycerine (65%), polyacrylamide and wa-ter. It does not allow bacterial or fungal proliferation and absorbs the fluids. With this dressing there is no necessity to use topical or oral antibiotics after surgery.

Cutting out the roof of the blisters Roof of the blisters over the receptor area Dressing with Elasto-Gel™Transferring the blisters to skin

After 1 week the dressing were removed from receptor and donor area. In the forehead we can see in the upper half the pigmentation just 1 week after surgery. In the lower half the roof of the blisters had not detached. Three weeks after surgery the patient was submitted to phototherapy with narrow-band ultraviolet B twice a week to aid in repigmentation.

After 9 months the color match was perfect and there are no dyschromia on donor area..

After one week the dressing was removed Donor area after 6 monthsAfter 9 months the color match was perfect

• Falabella R. Surgical therapies for vitiligo. Clinics in Dermatology. 1997; 15: 927-39• Lahiri K, Malakar S, Sarma N, Banerjee U. Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm) - a prospective study.

Int J Dermatol. 2006; 45: 649-55• Gupta S, Shroff S, Gupta S. Modified technique of suction blistering for epidermal grafting in vitiligo. Int J Dermatol. 1999; 38: 306-9