Using the ball-shaped attachment of a radiofrequency ablation device for preparation of recipient site in vitiligo surgery.

Sir,

Vitiligo surgeries – like autologous melanocyte transfer and suction blister grafting – involve some form of epidermal ablation as part of preparation of the recipient site. The usual methods used include motor dermabrasion, carbon-dioxide lasers, Erbium-YAG lasers or manual dermabrasion. Motor dermabrasion, while being very effective, requires a great deal of skill and time. Lasers have a major limitation of being costly and thus being inaccessible to many dermatologists. Manual dermabrasion is simple and has the advantage of being cheap, but can be very tedious and time-consuming by itself.[1-3] We describe a simple method of combining radiofrequency ablation with manual dermabrasion for preparation of graft recipient sites in vitiligo surgery.

After informed consent is obtained and surgical cleaning of the area is done, the procedure involves application of a ball-shaped loop of a radiofrequency device [Figure 1]. A power of 50% of maximum is used in the cut/coagulation mode. This is followed by superficial blistering [Figure 2]. Gauze is then used to wipe off the ablated epidermis. Following this, the area is abraded lightly with a manual dermabrader to induce pinpoint bleeding [Figure 3].

Figure 1

Using the ball-shaped radiofrequency probe for ablating the epidermis

Figure 2

Superficial blistering with separation of epidermis following radiofrequency application

Figure 3

Epidermis wiped with gauze followed by mild manual dermabrasion

Our method was tried in five patients with stable vitiligo (three cases of segmental vitiligo and two cases of vitiligo vulgaris). Only small areas (not exceeding 10 cm2) were treated using this method at one time. No specific difference in rate or extent of pigmentation was seen in the areas treated using this method as compared to the areas treated with either motor or manual dermabrasion alone (Carbon-dioxide laser was not used in any of our cases). There was also no incidence of other complications like significant infections or scar formation.

The primary advantage of this method is the relatively lesser time taken for the graft site preparation. Moreover, it is a cheaper alternative as compared to a carbon-dioxide laser. The specific advantage of using the ball-shaped attachment is that it is very easy to apply and has minimal risk of deeper damage. It should however be noted that the radiofrequency loop is to be used only for epidermal ablation and not deeper.

To conclude, combining superficial radiofrequency ablation with manual dermabrasion can be a simple and effective method for graft recipient site preparation in vitiligo surgery.