The clinical experience for treating post-burn depigmentation with tiny epidermal particles graft

Abstract

The critical problem of post-burn depigmentation is the lacking normal melanocytes. Auto-skin grafting and autologous non-cultured epidermal cell suspension have been used to improve the appearance. However, a large amount of skin graft is required of donor sites in the former method, while the latter method is thought to be complicated and costly. This study is designed to generalise the experience of tiny epidermal particles graft (TEPG) for treating post-burn depigmentation. From 2012 to 2013, 30 consecutive patients with depigmentation caused by burn injuries were divided into I and II group. I group: 15 cases (11 males and 4 females) were treated by the TEPG. II group: 15 patients (10 males and 5 females) were treated by suction blister epidermal skin graft (SBEG). Imagine-Pro Plus software was used to evaluate the size of repigmentation (RP) 12 months post-surgery. SPSS software 13.0 was used to evaluate the data. The optimum rate of RP was defined as more than 75% (RP > 75%) when excellent RP was defined as more than 90% (>90%). All patients were followed up for 12 months. The mean size of RP in two groups demonstrated that there were statistically significant differences in pigmentation between the two groups (P = 0·002), while there was no significant difference in the other factors (gender, site and age). No infection occurred in the recipient site. Pathological result showed that melanocytes existed at the basal layer of resurfacing skin. Optimum RP (RP > 75%) was seen in 12 patients in I group and 9 patients in II group. Excellent RP was achieved in 14 cases in I group and 10 patients in II group. Excellent RP can be obtained by the abovementioned two surgical techniques. In contrast to SBEG, TEPG is less traumatic, and definite effects can be guaranteed. It is a preferred treatment, especially for those patients who suffer from large depigmented lesions.

Keywords: Depigmentation; Post-burn; Repigmentation; SBEG; TEPG.

Figure 1

Staining method of silver and ammonia: No melanocytes were distributed on the basal level of the scar skin (A); Melanocytes were distributed on the basal level of the normal skin (B); Melanocytes were distributed on the basal level of the scar skin after TEPG transplantation (C).

Figure 2

Depigmentation was located on the forehead. Skin graft was harvested from the auricular area (A). Trim the skin graft into pattern of pulp (tiny epidermal particles graft, TEPG) by tissue scissors (B); Repigmentation was found on most sites of the forehead, and leukoplakia also existed after 6 months (C); The area of depigmentation was decreasing, only to find some scattered areas 12 months after the operation (D). No hypertrophic scar was seen, and minor hyperpigmentation was found on the donor site of the lateral chest wall (E).

Figure 3

Depigmentation existed, and tiny epidermal particles graft (TEPG) was used bilaterally (A). The majority of depigmented area were resurfaced, although the depigmentation of margin between the normal skin and initial dipigmentated skin was also observed more on the right side and less on left side 12 months after the operation (B). No conspicuous scar or hyperpigmentation can be found on the donor site of chest wall (C).

Figure 4

Depigmentation was found on the right skin of breast (A). Good repigmentation was treated by suction blister epidermal grafting (SBEG) 12 months post‐surgery (B). Donor sites of the back can be seen with minor hyperpigmentation (C).

Figure 5

Left wrist was characterised as leukoderma (A). Fine repigmentation was treated by suction blister epidermal grafting (SBEG) 12 months post‐surgery, although some dotted dyspigmented areas were also found (B).