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Punch Grafting

Punch Grafting

Best Cost of Punch Grafting for Vitiligo Treatment.

Punch Grafting is a simple and effective treatment for focal areas of vitiligo/White Patches. We perform Punch Grafting in Delhi as per the requirement.

What is Punch Grafting?

Punch Grafting is a simple and effective treatment for focal areas of vitiligo. Vitiligo is a skin disorder in which it loses melanin that is responsible for determining the skin, hair and eye color.  As a result, the melanin-producing cells die, thereby leading to the growth of white patches of irregular shapes on the skin. It usually starts with small areas of pigment loss and gradually spreads to larger skin area, with time. Such changes in skin often become a cause for worrying and stressing about appearance. Punch grafting is a therapy that addresses the worries and concerns arising due to vitiligo.

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How does Punch Grafting work?

Miniature punch grafting is the simplest and the most reasonable treatment of all the grafting procedures for treating vitiligo. Also known as minigrafting, the process involves transferring of punches or circular pieces of skin tissue from the donor area to similar shaped pits which are made on the skin of the recipient. The size of the punches varies between 1 mm to 2 mm and they are spaced 5-10 mm apart on the recipient skin. In this process, PUVA might be required and then the skin colors are unified between the graft sites.

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Advantages of Punch Grafting:

  • It is the easiest and most reasonable method of treating vitiligo.
  • The process can be used for all areas except nipples and angles of the mouth where involuntary muscular contraction interferes with the uptake of the graft.
  • It is also suitable for treating difficult locations such as toes, fingers, palms, soles, etc.


Disadvantages of Punch Grafting:

  • This process is not suitable for large lesions since uniform pigmentation might not be achieved all the time.
  • There are other complications of this treatment such as appearance of polka dots and cobblestoning, which are quite serious in nature and demand attention.


Complications associated with Punch Grafting:

Although least expensive, this treatment has the highest degree of adverse consequences that includes appearance of polka dots, graft rejection, hypertrophic scarring, depigmentation of the grafts and cobblestone appearance.


How to avoid some of these complications?

Cobblestoning: It is the most common and the most stressful complication associated with punch grafting. There are certain ways by which the chances of cobblestoning can be prevented:

  1. By using smaller size of punches, 1 mm to 1.5 mm during the surgery. Minigrafting processes done with smaller punches leads to lesser cobblestoning effect.
  2. Surgeons can prevent overcrowding of grafts. This can be done by keeping the grafts 5 mm apart from each other.
  3. It is better to use thinner grafts since the upper surface of the grafts remains at the level of recipient skin. Thin grafts can be obtained by infiltrating the skin of the donor with local anesthetic solution at the upper and mid dermis level only in order to separate the deeper dermis from the upper skin. In this way, the punch depth can be reduced thereby snugly fitting the graft in a relatively deeper punch made at the recipient area.
  4. In case thicker graft is taken, it is better to trim it under the graft surface.
  5. By minimizing the tissue trauma during the surgical procedure, cobblestoning can be prevented. Surgeons can use sharp cutting instruments and non-toothed forceps in order to prevent any kind of damage to the graft cells.
  6. Another way to prevent this complication is using the same size of punch for both the donor and the recipient skin.
  7. Finally, by using a silicon sheet dressing, the chances of cobblestoning can be prevented.

Depigmentation of grafts: This complication can happen after any kind of tissue grafting procedure. Ways by which the adversities can be controlled are as follows:

  1. Doctors must carefully select their patients before undertaking the procedure.
  2. In case there is doubt about the stability of vitiligo, surgeons can perform test grafting only in selected areas where only few mini-grafts will be transplanted to the recipient area before the main surgery is conducted. They can observe the test grafts over some time in order to see the repigmentation response. Positive results with test grafting don’t always guarantee success, however negative results will at least avoid the complication with the main grafting process.
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  4. By employing a proper surgical technique and minimizing tissue trauma both at the donor and the recipient site, graft depigmentation can be avoided.
  5. Finally, doctors can use PUVA OR UVB after the grafting process, when the onset of repigmentation delays.

Perigraft halo: In this complication, the rim of depigmentation remains at the outer edge of the vitiligo cut when treated with cellular or tissue grafting. By following a proper surgical method, this complication can be avoided. The grafts can be first placed along the periphery and then at the centre of the cut which is to be treated. By placing the grafts about 1-2 mm apart inside the outer border of the recipient skin, perigraft halo can be prevented.
Other Complications: Some other complications such as hypertonic scarring, graft rejection and Koebner’s phenomenon can be treated by preventing both sub-clinical and clinical infection at the donor and recipient site. For this, patients must be selected properly before proceeding towards surgery.
Cost of Punch Grafting process: In India, the average cost of punch grafting would be around $1000. However, the cost of surgery also depends on the condition of the patient, areas that have been infected by vitiligo and other factors. There are different clinics where overall costs vary. At the same time, there are after-surgery treatments which might involve additional costs.


Finding the right doctor for Punch Grafting:

Before opting for punch grafting for treating vitiligo, it is very important to find the right doctor. The surgeon performing the process should be qualified and experienced enough and understand its methodologies. Before selecting the clinic or the doctor, it is best to have a prior consultation and know the outcomes and stay prepared accordingly.

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1, NRI Complex, Mandakini,
Chittaranjan Park, South Delhi,
New Delhi - 110019

(+91) 9818704499