Noncultured Epidermal Suspension in Vitiligo-A Review of Origins, Modifications, and Innovations for this Surgical Masterstroke!

Vitiligo, a disorder of depigmentation, has a profound psychosocial burden. Surgical techniques using transplantation of tissue grafts or melanocytes have long been used to correct vitiliginous macules, often utilizing noncultured epidermal suspension. This procedure has undergone a remarkable transformation from its original methods in terms of preparation of recipient site, concentration and separation of melanocytes, incubation, and cryofreezing.Vitiligo is an acquired hypomelanotic disorder characterized by depigmented and circumscribed macules or patches, with loss of melanin and functional melanocytes from the epidermis. There is a broad range of therapeutic options for vitiligo, including topical agents, ultraviolet therapy, oral therapy, and surgical modalities. Transplanting autologous melanocytes from a normally pigmented donor area to the depigmented skin forms a common principle in all surgical techniques-be it grafting at tissue level or cellular level.1Surgical modalities are further divided into tissue grafts and cellular grafts. Tissue grafting includes thin dermoepidermal grafts, punch grafts with full thickness, suction blister grafts, and epidermal harvesting systems. Cellular grafting employs noncultured epidermal suspensions and cultured melanocyte suspensions.1 The advantages of cellular grafting include large areas of depigmentation that can be treated with ease. In noncultured epidermal cell suspensions (NCES), keratinocytes are not separated from melanocytes, and they help to furnish factors that sustain and promote growth of melanocytes and homogeneity of repigmentation.2 A minimum density of melanocytes required for satisfactory repigmentation is 210-250 per mm.2,3.