Surgical modalities of treatment in vitiligo

Vitiligo is an acquired disorder of depigmentation that is associated with immense stigma and psychological burden. Although there is a myriad of options available for therapy, the repigmentation is best achieved with surgical modalities for stable disease. Once the immune attack on melanocyte is halted, surgery can be undertaken. The principles of surgery may be to introduce artificial pigment, stimulate melanocyte proliferation and migration, removal of depigmented areas or repopulation of depleted melanocytes. Broadly these can be divided into grafting, non-grafting techniques, camouflage and excision. The grafting techniques are further divided into cellular and tissue grafts. The advantage of the former being a greater donor to recipient ratio, however with added cost and equipment requirement. Grafting techniques have undergone various innovations, be it in harvesting, recipient site preparation or dressing, each with their own advantages and disadvantages. New innovations continue to crop up, including the use of stem cells and regulatory T-cell modulation. A well performed surgery is incomplete if it was not done without proper patient selection, counseling and preparation. This review article briefly outlines the various techniques; pre, intra and post-operative intricacies and the innovations in each.