Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
PRACTICE POINTS  
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 132-135
Innovative technique for securing autologous melanocyte-keratinocyte cell transplant (MKCT) suspension in stable vitiligo


Department of Dermatology, Maharashtra Medical Foundation’s Joshi Hospital, Pune, Maharashtra, India

Click here for correspondence address and email

Date of Web Publication27-Mar-2021
 

   Abstract 

Autologous cultured melanocyte transplantation is a safe and effective cellular regenerative surgical treatment modality for the lesions of stable vitiligo. Research continues to improve the efficacy of cell transplants by refining the procedure. The method of dressing used to secure the cell suspension over the treated site is vital in deciding the extent of repigmentation. The authors propose a simple modification in the dressing technique, which provides better graft adherence and results in uniform repigmentation, especially on challenging areas such as joints and other curved body surfaces.

Keywords: Cellular graft, innovation, surgery, vitiligo

How to cite this article:
Mutalik SD, Rasal YD. Innovative technique for securing autologous melanocyte-keratinocyte cell transplant (MKCT) suspension in stable vitiligo. J Cutan Aesthet Surg 2021;14:132-5

How to cite this URL:
Mutalik SD, Rasal YD. Innovative technique for securing autologous melanocyte-keratinocyte cell transplant (MKCT) suspension in stable vitiligo. J Cutan Aesthet Surg [serial online] 2021 [cited 2021 Jul 23];14:132-5. Available from: https://www.jcasonline.com/text.asp?2021/14/1/132/311823





   Practice Points Top


  • Precise delivery of autologous MKCT suspension on a curved donor site is challenging.


  • Cell suspension smeared on cut-to-size collagen-tulle composites ensures optimal and uniform delivery.


  • Unique handling of cell suspensions ensures uniform repigmentation.



  •    Introduction Top


    Autologous MKCT is an effective cellular grafting technique that is used for the surgical treatment of stable lesions of vitiligo.[1] The extent of repigmentation achieved with this technique depends on multiple factors, including the type and method of dressing used to secure the cell suspension over the treated site. The authors’ goal is to describe an innovative technique of both delivering and securing the MKCT suspension over the recipient area.


       Background Top


    In 1998, Olsson and Juhlin described the use of collagen dressing to cover the dermabraded recipient area after spreading of the resuspended cell suspension with a 1ml tuberculin syringe.[2] [Figure 1]. The dressing was then finalized by using sterilized soft gauze and transparent adhesive dressing and fixed with nonwoven rayon back (micropore) surgical adhesive tape at the borders.[3],[4]
    Figure 1: Conventional method of spreading the cell suspension

    Click here to view


    The cell suspension spreads evenly when the recipient anatomical site is flat, but it tends to seep out and get wasted when the anatomical site has a curve or a slope. This leads to a varied distribution of the transplanted melanocytes, resulting in incomplete and un-uniform repigmentation. To overcome this limitation, Van Geel et al. modified the technique by adding hyaluronic acid gel to the cell suspension, which prevents spillage to some extent, thereby achieving uniform spread of the harvested cells and increasing the adherence of the cells to the recipient site.[3] We have further modified the dressing method for a more even spread and better securing of the cell suspension, especially over curved anatomical surfaces in view of achieving effective MKCT in stable vitiligo lesions.


       Technique Top


    The steps of the dressing method with the modification suggested by us are as follows:

    1. The cell pellet containing melanocytes and keratinocytes is reconstituted in a viscous hyaluronic acid to create a semisolid gel.[4]


    2. A dry collagen sheet is placed over a chlorhexidene impregnated tulle dressing (Bactigras. Smith and nephew) cut to size and shape, such that it complements the recipient site [Figure 2].


    3. The gel containing the cell suspension is spread over the collagen-tulle composite with a small spatula to form a film [Figure 3]. The entire procedure is carried out in a laminar flow chamber to prevent contamination.


    4. This composite dressing smeared with the cellular suspension is then placed face down on the dermabraded/ laser abraded raw recipient area [Figure 4].


    5. Without disturbing the composite dressing, the butter-paper cover over the tulle is gently and carefully peeled off with a jeweller’s forceps [Figure 5].
    Figure 2: Dry collagen sheet cut to the shape placed over a chlorhexidine-impregnated tulle dressing

    Click here to view
    Figure 3: Cell suspension gel being spread over collagen-tulle composite with a spatula

    Click here to view
    Figure 4: Facedown composite dressing over dermabraded recipient area.

    Click here to view
    Figure 5: Carefully peeling off butter paper cover with a jeweller’s forceps without disturbing the composite dressing

    Click here to view


    Further buttressing is achieved with sterile gauze pieces, secured with a transparent adhesive dressing (Tegaderm), which is then fixed with a micropore surgical tape at the borders. If the treated area is over the joints, it is reinforced with a compression bandage.


       Discussion Top


    Since the application and implementation of this modification in the cellular transplantation and dressing technique, we have certainly experienced a better and easy handling of the cell suspension without any cell spillage and wastage. This simple method ensures meticulous and almost perfect MKCT, especially on curved body surfaces such as lips, jawline, breasts, and over the joints.

    This innovative technique has helped us achieve uniform repigmentation of the vitiligo lesions with a complete blend and aesthetically pleasant outcomes [Figure 6], as compared with the results achieved with the conventional dressing technique used earlier. More number of prospective comparative studies will help establish our observations.
    Figure 6: Complete and uniform repigmentation at a difficult anatomical site

    Click here to view


    Declaration of patient consent

    The authors certify that they have obtained all appropriate patient consent forms. In the form/ forms, the patient(s) has/ have given his/ her/ their consent for his/ her/ their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
       References Top

    1.
    Gauthier Y, Surleve-Bazeille JE Autologous grafting with noncultured melanocytes: A simplified method for treatment of depigmented lesions. J Am Acad Dermatol 1992;26:191-4.  Back to cited text no. 1
        
    2.
    Olsson MJ, Juhlin L Leucoderma treated by transplantation of a basal cell layer enriched suspension. Br J Dermatol 1998;138:644-8.  Back to cited text no. 2
        
    3.
    van Geel N, Ongenae K, De Mil M, Naeyaert JM Modified technique of autologous noncultured epidermal cell transplantation for repigmenting vitiligo: A pilot study. Dermatol Surg 2001;27:873-6.  Back to cited text no. 3
        
    4.
    Mutalik S, Shah S, Sidwadkar V, Khoja M Efficacy of cyclosporine after autologous noncultured melanocyte transplantation in localized stable vitiligo-A pilot, open label, comparative study. Dermatol Surg 2017;43:1339-47.  Back to cited text no. 4
        

    Top
    Correspondence Address:
    Sharad Dattatray Mutalik
    Department of Dermatology, Maharashtra Medical Foundation’s Joshi Hospital, Pune, Maharashtra.
    India
    Login to access the Email id

    Source of Support: None, Conflict of Interest: None


    DOI: 10.4103/JCAS.JCAS_143_20

    Rights and Permissions


        Figures

      [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



     

    Top
      
     
      Search
     
      
        Similar in PUBMED
       Search Pubmed for
       Search in Google Scholar for
     Related articles
        Email Alert *
        Add to My List *
    * Registration required (free)  


        Abstract
       Practice Points
       Introduction
       Background
       Technique
       Discussion
        References
        Article Figures

     Article Access Statistics
        Viewed458    
        Printed6    
        Emailed0    
        PDF Downloaded28    
        Comments [Add]    

    Recommend this journal