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Minigrafting and punch grafting
Minigrafting and punch grafting
PG was first described by Falabella for use in vitiligo in 1978, when 1- to 2-mm punch grafts were associated with perigraft pigment spread of approximately 3 mm. In 1983, Falabella observed that a graft size of 1 mm could lead to repigmentation of a vitiliginous area 25 times that size.32 Although cobblestoning was commonly reported initially, it was observed that this textural abnormality could be avoided if smaller punches were taken, leading to the advent of MPG. The standing recommendation is that punches should not exceed 1.5 mm and in areas involving the face and lips, the preference is between 1- and 1.2-mm punches.4
Using this method, grafts are transferred from the DS into RS chambers using either a syringe needle or the tip of scissors and placed in close proximity to the border of the depigmented lesion. This reduces the risk of perigraft halo. RS punches are spaced approximately 5 to 10 mm apart from each other, with slightly larger DS punches used to account for graft contracture. Dressings are removed after approximately 7 days. Complete repigmentation is typically observed by 3 to 6 months.32
Complications such as cobblestoning, color mismatch, hypertrophic scarring, keloid formation, and graft rejection can occur at the RS. DS complications may include depigmentation and scarring. Of all of the available vitiligo surgery techniques, PG and MPG are considered the easiest, fastest, and least costly. With the exception of the angle of the mouth, the treatment can be used anywhere.32
A study comparing MPG with STSG in 64 patients with stable focal, segmental, acrofacial, and vulgaris vitiligo subtypes found that patients who underwent STSG had greater repigmentation, better color matching over larger areas using fewer grafts, and less graft failure.33 Another study involving 50 patients with stable focal, segmental, and generalized vitiligo types compared PG with SBEG and found that SBEG showed faster repigmentation and better cosmesis.34 Perigraft halo at the RS is seen more commonly with PG than SBEG.11