Tissue grafting: Following techniques can be used:

1. Punch grafting: In this technique grafts are punched put (1-2mm in diameter) from the pigmented skin (called as donor sites), usually from thighs, buttocks, posterior ear, upper arm. Then sockets are created in the area of depigmented skin (called as donor area), and these grafts are replaced in these sockets. Post operatively dressings are placed on the operated sites. Usually in 7-10 days the grafts are taken up by the recipient skin, and patient is now treated with phototherapy topical steroid for even spread of pigment.

Advantages:This method is fairly inexpensive and effective for all areas except angle of mouth and nipples. This technique is also effective in areas like fingers, toes palms, and soles which are otherwise difficult to treat.

Disadvantages:This technique is not suitable if large areas are involved.

2. Suction blister epidermal grafting: In this technique, very thin grafts (consisting of epidermis only) are harnessed from the donor area by applying a prolonged suction pressure which leads to a physiological split at dermo epidermal junction. These grafts are then applied on the recipient site after abrading it. The graft typically falls of within 7-10 days.

Advantages:As the grafts are very thin, it gives excellent cosmetic results. Chances of scarring are minimal both at donor and recipient sites.

Disadvantages:It is a time-consuming process as the grafts take time to separate, thus large areas can also not be treated.

3. Split thickness grafting:In this technique, the grafts consists of epidermis with a portion of dermis. Local anaesthesia is required for small areas and for large areas patient may require general anaesthesia. The split thickness graft is transplanted on abraded skin on recipient site, further secured by pressure and immobilization.

Advantages: is a good technique to treat large areas in short span of time.

Disadvantages:This technique requires lot of skill and expertise. There is a probability of donor site scarring and colour mismatch and undesirable pigmentary changes on recipient site.

Cellular grafting: Following techniques are available:

1. Non-cultured melanocyte grafting:This technique involves taking a biopsy sample from the recipient skin, which is then immersed in trypsin solution to separate epidermis from dermis. This is followed by obtaining the cellular suspension of melanocytes which is then transplanted on abraded on recipient site.

Advantages:This method is suitable for treating fairly large areas.

Disadvantages:This method requires high level of expertise, and equipped laboratory.

2. Transplantation of cultured autologous melanocytes:This technique involves culturing melanocytes in vitro (outside body, in a culture medium in laboratory). The culture growth takes 15-30 days, after which the isolated melanocytes in suspension are transplanted on abraded donor area.

Advantages:This technique can treat unlimited body areas. In cases where more than 30 % of body is involved, this technique is useful.

Disadvantages: This technique is quite expensive and requires elaborate tissue culture laboratory setup.

3. Autologous cultured epithelial grafts:In this technique, an epidermal sheet is obtained through cell culture. This takes few weeks to grow. This epidermal sheet is then attached on a petrolatum gauze and applied on recipient site and dressing is done.

Advantages:Large areas of skin can be treated.

Disadvantages:Its expensive and requires skill and equipment.

Who Are Candidates Of Vitiligo Surgery?

• When a patient has undergone medical therapy and light therapy, but the results aren’t satisfactory.
• In the adult patients where the vitiligo has been stable for 1 year (no development of new patches or current patches have not expanded).

Who Are Not So Good Candidates For Surgery?

• Unstable disease
• Children
• Patients who forms scars and keloid easily or have such history.