الفهرس 
Introduction
Chapter (1): VitiligoOnly 14 pages are availabe for public view
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Abstract
Surgical modalities that have been used in vitiligo are cosmetic tattooing, thin Thiersch’s graft, grafting with the suction blister technique, minigrafting and punch grafting, epidermal sheet grafts and skin culture autologous or fetal containing both keratinocytes and melanocytes or melanocytes alone followed by grafting.
Stable vitiligo usually responds well to surgical grafting, e.g. epidermal sheet grafts and autologous minigrafting. This can be explained by the fact that failure to respond to medical or conventional lines of treatment indicates that the melanocyte reservoir is no longer available in such vitiliginous skin and is an indication for surgical transfer of melanocytes.
The present study was carried on 70 patients with stable vitiligo. The patients were divided into two main groups according to the technique of treatment used; where 50 patients had undergone 2mm punch minigraft (group 1 G1) while the other 20 patients had undergone split thickness epidermal graft (group 2 G2). The age of the studied patients ranged from 10-45 years with a mean ± SD of 23.31 ± 5.65 years.
The study was conducted in The Department of Dermatology, Venereology and Andrology and The Plastic Surgery Department, Assiut University Hospital from the begining of September 2010 till the end of March 2013.
Post-operative repigmentation response was monitored and the percentage of complications was recorded during a follow up period of 6 months.
Among 50 patients treated by 2mm punch minigraft technique (Group1), repigmentation (multiple islands of pigmentation that later coalesced to a uniform color) was observed with a mean of repigmentation of 62.6% with a range of 0-100%.
Correlation between different age groups of the studied population and the repigmentation response showed that patients < 20 years of age gave higher percentage of excellent repigmentation (35%) compared to older age groups.
Segmental, focal and generalized vitiligo were reported in 12%, 34% and 42% respectively of the studied group with different effect on the repigmentation response for each type. There was higher percentage of excellent repigmentation response (41.66%) in patients with segmental type of vitiligo than those with focal and generalized types.
Different sites of vitiligo lesions were minigrafted (face, trunk, upper limb and lower limb) in order to study the impact of site variation on repigmentation response. Among the studied lesions, cases with facial involvement showed the highest percentage of excellent responses (88.8%) compared to other sites.
In the current study, at least 6 months duration without progression was chosen to define stable vitiligo and to declare patients as eligible for epidermal grafting. Correlation between the repigmentation score of the treated areas and duration of stability of the disease was statistically significant.
To study the role of adjuvant phototherapy on repigmentation results after minigraft treatment, 23 patients received adjuvant phototherapy either PUVA or narrow band UVB each of which was taken at a rate of two settings per week for 6 months. The other 17 patients did not receive any adjuvant therapy following the minigraft. Grading of repigmentation in both groups with adjuvant phototherapy was significantly higher than those without any adjuvant therapy.
In the present study, 20 patients had undergone split thick skin grafts with a mean age ± SD (22.9 ± 4.04). The overall results of split thickness graft group G2, (75%) of patients got excellent and good responses, a fair and poor in (25%) of patients.
Similar to the minigraft group (G1), follow up of split thickness graft group of patients (G2) showed better repigmentation response in patients < 20 years of age, focal type of vitiligo, non articular sites and those with longer duration of stability of the disease.
However, no statistically significant difference in the effect of post graft adjuvant phototherapy was reported on repigmentation response in (G2).
On studying the efficacy of both techniques, punch minigraft and split thickness graft, in treating stable vitiligo, no statistically significant difference in repigmentation response was noted.
After both techniques, assessment of patients without adjuvant photostherapy, it was found that the split thickness group gave significantly higher percentage of excellent response (30%) compared to the minigraft group.
On comparing the effect of adjuvant NB UVB on both techniques, minigraft technique showed significantly higher percentage of excellent response (38.9%) compared to those treated by split thickness graft technique.
Complications of the minigraft group comprised the cobblestoning in 6% of cases, graft displacement in 10% and koebnerization in the donor area in one case only.
Regarding the complications of the split thickness grafts technique graft displacement was observed in (10%) of patients, secondary infection in (10%) and donor site depigmentation developed in one patient.