Journal of Cutaneous and Aesthetic Surgery
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LETTER  
Year : 2011  |  Volume : 4  |  Issue : 3  |  Page : 216-217
Surgical excision and primary closure for the treatment of lip vitiligo


Departments of Dermatology, STD and Leprosy, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

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Date of Web Publication28-Dec-2011
 

How to cite this article:
Sacchidanand S, Purohit V, Sujaya S N. Surgical excision and primary closure for the treatment of lip vitiligo. J Cutan Aesthet Surg 2011;4:216-7

How to cite this URL:
Sacchidanand S, Purohit V, Sujaya S N. Surgical excision and primary closure for the treatment of lip vitiligo. J Cutan Aesthet Surg [serial online] 2011 [cited 2019 Aug 17];4:216-7. Available from: http://www.jcasonline.com/text.asp?2011/4/3/216/91259


Sir,

Surgical excision and primary closure is one of the surgical procedures which are used for the treatment of stable vitiligo over the lip region.

A 30-year old male patient presented with two de pigmented macular lesions on the lower lip since last 3-years. The patient had undergone treatment in the form of various topical agents and systemic drugs, but there was no response. The size of the lesion was stable for the past 2-years and there were no new lesions noted elsewhere on the body.

On examination, there were two de pigmented macules of size 1 × 0.5 cm on the midline of the lower lip [Figure 1].
Figure 1: Pre operative photograph

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A diagnosis of vitiligo was made on the basis of clinical findings.

As the lesions were stable and the patient was not showing any response to medical treatment, surgical excision and primary closure were suggested as treatment to the patient. An informed consent was taken. Surgical excision of both the lesions was done with a number-15-blade [Figure 2]. Undermining was done with the blade and anterior and posterior borders of the wound were sutured using a 5-0 plain catgut suture [Figure 3]. Simple paraffin gauze dressing was done. Sutures were removed on the fifth day as by that time the healing was complete. No post-operative complications were noted [Figure 4].
Figure 2: Wound created after excision of vitiliginous macules

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Figure 3: Sutured wound

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Figure 4: Post operative photograph at 4 weeks

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Different surgical modalities are used for the treatment of lip vitiligo which include punch grafting, [1] split-thickness grafting, [2] ultra thin skin grafting, [3] suction blister grafting, [4] and autologus melanocyte transplant. [5]

However surgical excision and primary closure have certain advantages.

This procedure gives immediate results as compared to other surgical modalities which take a long time to re pigment. There is no uncertainity of results like in other procedures. There is no risk of displacement of grafts like in skin grafting methods, no cobble stoning as in mini punch grafting, no post operative hyper pigmentation as in suction blister grafting, no special equipments required and no need to maintain patient on a liquid diet. The wound also heals fast.

However, this method has some limitations.

It cannot be performed for a larger area. It may lead to alteration in the shape of the lip if there is excessive tension on the wound edges.

Excision, undermining and primary closure appears to be an effective method for treating small patches of lip vitiligo. This case is presented to stress upon the effectiveness of surgical excision and primary closure in stable lip vitiligo, especially in patients not responding to medical treatment.

 
   References Top

1.Falabella R. Pigmentation of leucoderma by minigrafts of normal pigmented autologus skin. J Dermatol. Surg. Oncol 1978;4:916-9.  Back to cited text no. 1
    
2.Behl PN. Thin Thiersch's graft in the management of vitiligo. Asian Clin Dermatol 1994;1:69-76.  Back to cited text no. 2
    
3.Kahn AM, Cohen MJ. Repigmentation in vitiligo patients. Melanocyte transfer via ultra thin grafts. J Dermatol.Surg-1999;25:69-670.  Back to cited text no. 3
    
4.Gupta S, Sandhu K, Kanwar A, Kumar B. Melanocyte transfer via epidermal grafts for vitiligo of labial mucosa. J Dermatol Surg 2004;30:45-8.  Back to cited text no. 4
    
5.Gupta L, Cappuro S, Melchi F, Primavera G, Bondanza S, Cancedda R, et al. Treatment of stable vitiligo by timed surgery and transplantation of cultured epidermal autografts. Archives of Dermatol 2000;136:1380-89.  Back to cited text no. 5
    

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Correspondence Address:
Venkatesh Purohit
Departments of Dermatology, STD and Leprosy, Bangalore Medical College and Research Institute, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2077.91259

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Mucosal Advancement Flap: An Innovative Surgical Technique for Treatment of Lip Vitiligo
Raghunatha R. Reddy,Shashikumar M. Basavapura,Girish A. Chandramouli
Dermatologic Surgery. 2013; 39(2): 334
[Pubmed] | [DOI]



 

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