白癜风的病程包括进行期和静止期。静止期的白斑表现为大小固定不变，没有新发白斑，往往对药物治疗和光疗反应不佳，这时可以采用一种外科治疗方法——吸疱法表皮移植术。就是将患者自身正常色素的皮肤移植到白斑区，让白斑区色素再生，这种方法的有效率高。打个比方，白癜风就是一块荒地，没有种子(黑素细胞)，缺少肥料（免疫异常），药物治疗好比给地增加肥料、制造适宜种子生长的各种条件，促进残存黑素细胞的生长，外科手术则是将优良的种子---黑素细胞移植过来，在药物的辅助下，成长、繁殖。
这种方法对于面部、颈部暴露部位的静止期白癜风患者，尤为适合。术后配合药物治疗或光疗，以取得最佳的治疗效果。
表皮移植术是通过将携带黑素细胞的自身正常表皮移植到缺少黑素细胞的白斑处从而产生治疗效果的一种方法，又可分为发疱法和薄层皮片法。
What is vitiligo?
There are pigment producing cells in our skin (melanocytes) which give color to skin, because of some defects these cells either become dormant/dead resulting in producing less or no pigment. So there is formation of white patches on the skin.
There is only loss of pigment in that area otherwise skin is healthy.
It can affect any age and sex regardless of race.
It is more noticeable in dark skin color.
What causes vitiligo?
The exact cause of vitiligo is unknown, but it is often considered to be a combination of genetic, immunologic and environmental factors. This means that some people may have a greater tendency to develop the disease when exposed to the right trigger.
Is Vitiligo communicable?
Absolutely not. It can not be transmitted from person to person. However possibility of genetic transmission can not be ruled out
What treatments are available for vitiligo patients?
The goal in treating vitiligo is based on two basic approaches- either we try to restore the normal pigment in the vitiligo patches by medicines or surgery or we try to destroy the remaining pigment cells if the most of body surface area has lost the pigment called depigmentation therapy.
Treatment choices for vitiligo are based on the number of white patches you have and how widespread they are. Each person responds differently to treatment, and a particular therapy may not work for you.
Treatment modalities for vitiligo can be divided into Medical and surgical treatment.
What are medical treatments for Vitiligo?
There are lots of medical treatments which can be given for oral use or for topical use. Just to name a few Psoralens, steroids, calcipotriene, Ultraviolet light therapy etc.
When do patients need surgical treatment?
Surgical treatment is needed when in spite of best medical treatment the lesions have become recalcitrant and stable (not responding to treatment).
So, if lesions are stable i.e. neither increasing in size nor new lesions are appearing the surgical treatment is indicated.
What is done in surgical treatment?
In surgical treatment the non pigmented skin is replaced by pigmented skin from the patient body itself called skin grafting.
There are different types of skin grafting-
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Therisch grafting
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Punch skin grafting
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Suction blister grafting
There are few drawbacks in above two techniques e.g. scarring and donor site, mismatch of color and texture and recipient, cobblestone appearance. Infection etc.
Suction blister grafting is best among all the options.
What is done in Suction blister grafting for Vitiligo?
With the help of specially designed apparatus pieces of skin is removed from the patient depending on size of lesion. Patient has to lie down on the table comfortably for 1-3 hours depending on the time of blister formation (which varies from person to person, age and site). After blister is formed, it is removed and applied on the lesion after removing the non pigmented skin of lesion.
From which donor site skin is removed for suction blister grafting in vitiligo?
It can be removed from thighs, buttocks etc.
Is the procedure painful?
No it is least painful. However Local anesthesia is given at the site. Patient can listen to music comfortably during the procedure.
Is there any complication if this procedure?
It is a procedure with least complications. Minor complications are infection on site and graft rejection. They can be managed easily later on.
When dressings are removed?
Dressing at donor site can be removed after 2-3 days but of recipient site it is kept 5-7 days.
Can a person do daily activities and go to work.
Absolutely he/she can do everything. He/she has to avoid wetting the dressing. Some time special precautions are needed depending on the operative site. This technique offers Drive in and Drive out concept.
Is there any color mismatch after procedure?
As for as color match is concerned, it is the best technique among all where there is absolute color match after this procedure. After some time no one is able to recognize that some procedure was done on site or not.
Is there any scarring on the donor site (site from where skin is removed)?
This technique does not cause any scarring on Donor site. We can have repeated grafts from same site.
Minor skin abrasions on donor site heal within 7-10 days.
Is color permanent with this technique?
Permanency of color cannot be guaranteed with any technique. May it be medical or surgical. It depends on the activity/non activity of disease process. Any surgical treatment is done only after the stability of disease process is confirmed.
发疱法自体表皮移植术是供皮区选择腹部、臀部、股部等非暴露部位皮肤，采用负压吸引、液氮、局部PUVA照射或者药物刺激等方法使局部皮肤起疱，从而达到真表皮分离的目的。
受皮区白斑目前多采用皮肤磨削术将表皮去掉，但也有仍然用液氮发疱或负压吸疱然后将疱皮去掉的方法。将供皮区水疱的疱壁沿着边沿小心剪下，然后贴于处理好的受皮区创面。
每个移植皮片一般为1cm*2大小，根据白斑的大小可同时取多块以覆盖整个白斑。这种方法的优点是设备简单廉价，供皮区损伤小，一般不会形成瘢痕，缺点是操作繁琐、手术时间长、治疗面积小，较大面积治疗费用高。
另外移植皮片间的遗留的白边使治疗不能一步到位，需有一定的时间方能完全融合恢复正常外观。在术后辅以UVA光疗、中药外用、黑素细胞生成素等方法可以加快皮片间白边消失的速度
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