- Email: [email protected]
An innovative use of an aerosol spray in surgical management of lip vitiligo: Our experience
Accepted Manuscript An innovative use of an aerosol spray in surgical management of lip vitiligo: Our experience Radhakrishnan Subramaniyan, MD, DNB, Navya Donaparthi, MD, Richa R, MBBS PII:
S0190-9622(19)30713-3
DOI:
https://doi.org/10.1016/j.jaad.2019.04.066
Reference:
YMJD 13429
To appear in:
Journal of the American Academy of Dermatology
Received Date: 5 April 2019 Revised Date:
24 April 2019
Accepted Date: 29 April 2019
Please cite this article as: Subramaniyan R, Donaparthi N, R R, An innovative use of an aerosol spray in surgical management of lip vitiligo: Our experience, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/j.jaad.2019.04.066. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT 1
Title page
1
Article type: Surgical pearl
3
Title: An innovative use of an aerosol spray in surgical management of lip vitiligo: Our
4
experience
5
Radhakrishnan Subramaniyan MD, DNB1 Navya Donaparthi MD 2 Richa R MBBS3
Corresponding author:
Navya Donaparthi Dept of Dermatology Command hospital Airforce, Agaram post Bangalore – 560007, India Tele: +91-80-25369030 Email: [email protected] Funding sources: None
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Resident, Command hospital Airforce, Bangalore – 560007, India
Conflicts of Interest: None declared. IRB approval status: Not applicable
EP
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Assistant professor, Command hospital Airforce, Bangalore – 560007, India
Clinicaltrials.gov (or equivalent) listing (if applicable): Not applicable Reprint requests: Navya Donaparthi
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Professor and Head of the Department, Armed forces medical college, Pune – 411040, India
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Manuscript word count: 250 words [excluding references, figures, tables] Abstract word count: Not applicable Capsule summary word count: Not applicable References: 1 Figures: 3 Supplementary figures: 0 Tables: 2 Supplementary tables: 0 Attachments: Nil Keywords: Lip vitiligo, Aerosol spray, Healex plus®
ACCEPTED MANUSCRIPT 2
Body of the manuscript
39
Surgical management of lip vitiligo though successful is challenging as lips are mobile and
40
dressing is difficult at this site.1 Hence we have come up with an easy and convenient way of
41
retaining graft in place with the help of an aerosol spray.
42
Our experience:
43
04 patients of lip vitiligo with minimum 01 year duration of stability were treated surgically with
44
tissue grafting. The demographic profile of the patients is shown in Table I. The procedure
45
involved asepsis, local anaesthesia and harvesting of either split thickness skin graft (SSG) or
46
suction blister epidermal graft (SBEG) from donor area (thigh in all cases), which was then
47
placed over manually dermabraded recipient site (lip) with the help of a glass slide. An aerosol
48
spray containing polyvinyl polymer, cetrimide and benzocaine (Healex plus® SHREYA LIFE
49
SCIENCES PVT LTD, Mumbai, India) was sprayed from distance of 4½" to 5" over properly
50
positioned graft on lip till it formed a thin film, taking care of the surrounding structures. The
51
graft used to get stuck onto the lip without requiring any further dressing following application
52
of spray (Figure 1). Patients were counseled about post procedure care. Patients were reviewed
53
after 01 week, 01 month and 03 months. Results are shown in Table II and Figures 2A and 2B.
54
At the end 0f 03 months, there was good or excellent repigmentation in all cases subjectively and
55
> 90% repigmentation in all 04 cases. Complications included stuck on appearance and
56
depigmentation of right lateral part of lower lip.
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ACCEPTED MANUSCRIPT 3
References:
58
1. Bhatia, Riti & Gupta, Somesh. (2018). Surgical Management of Vitiligo of Lips, Eyelids, and
59
Genitals: Medical and Surgical Management. 10.1002/9781118937303.ch42.
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ACCEPTED MANUSCRIPT 4
Figure legends
61
Figure 1: Lip vitiligo Patient 4, immediately after application of aerosol spray
62
Figure 2A: Lip vitiligo Patient 1, before procedure
63
Figure 2B: Lip vitiligo Patient 1 after 03 months of procedure
Table legends
66
Table I : Demographic profile of the patients
67
Table II: Results
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Table I : Demographic profile of the patients Patient
Age/sex Type of vitiligo
Duration of disease
Stability
1
16/F
Mucosal(Lower lip)
02 yrs
01 yrs
2
20/F
Mucosal (Lower lip)
03 yrs
3
24/M
Mucosal (Upper& lower 12 yrs
RI PT
68
02 yrs
02 yrs
52/M
Non
segmental 03 yrs
(Generalized
including
upper and lower lip) 69
Table II: Results
2 3 4
SSG
Subjective
Objective
Donor
response
response
complications
complications
(At the end of
(At the end of
03 months)
03 months)
Excellent
>90 %
None
Stuck
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1
Graft
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Patient
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70
02 yrs
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4
SC
lip)
site Recipient
site
appearance
SSG
Excellent
>90 %
None
None
SBEG
Good
>90 %
None
None
SBEG
Good
>90 %
None
Koebner’s phenomenon
71
SSG: Split thickness skin graft SBEG: Suction blister epidermal graft
on
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RI PT
ACCEPTED MANUSCRIPT
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ACCEPTED MANUSCRIPT
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ACCEPTED MANUSCRIPT
S0190-9622(19)30713-3
DOI:
https://doi.org/10.1016/j.jaad.2019.04.066
Reference:
YMJD 13429
To appear in:
Journal of the American Academy of Dermatology
Received Date: 5 April 2019 Revised Date:
24 April 2019
Accepted Date: 29 April 2019
Please cite this article as: Subramaniyan R, Donaparthi N, R R, An innovative use of an aerosol spray in surgical management of lip vitiligo: Our experience, Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/j.jaad.2019.04.066. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT 1
Title page
1
Article type: Surgical pearl
3
Title: An innovative use of an aerosol spray in surgical management of lip vitiligo: Our
4
experience
5
Radhakrishnan Subramaniyan MD, DNB1 Navya Donaparthi MD 2 Richa R MBBS3
Corresponding author:
Navya Donaparthi Dept of Dermatology Command hospital Airforce, Agaram post Bangalore – 560007, India Tele: +91-80-25369030 Email: [email protected] Funding sources: None
TE D
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
Resident, Command hospital Airforce, Bangalore – 560007, India
Conflicts of Interest: None declared. IRB approval status: Not applicable
EP
9
3
Assistant professor, Command hospital Airforce, Bangalore – 560007, India
Clinicaltrials.gov (or equivalent) listing (if applicable): Not applicable Reprint requests: Navya Donaparthi
AC C
8
SC
2
7
Professor and Head of the Department, Armed forces medical college, Pune – 411040, India
M AN U
1
6
RI PT
2
Manuscript word count: 250 words [excluding references, figures, tables] Abstract word count: Not applicable Capsule summary word count: Not applicable References: 1 Figures: 3 Supplementary figures: 0 Tables: 2 Supplementary tables: 0 Attachments: Nil Keywords: Lip vitiligo, Aerosol spray, Healex plus®
ACCEPTED MANUSCRIPT 2
Body of the manuscript
39
Surgical management of lip vitiligo though successful is challenging as lips are mobile and
40
dressing is difficult at this site.1 Hence we have come up with an easy and convenient way of
41
retaining graft in place with the help of an aerosol spray.
42
Our experience:
43
04 patients of lip vitiligo with minimum 01 year duration of stability were treated surgically with
44
tissue grafting. The demographic profile of the patients is shown in Table I. The procedure
45
involved asepsis, local anaesthesia and harvesting of either split thickness skin graft (SSG) or
46
suction blister epidermal graft (SBEG) from donor area (thigh in all cases), which was then
47
placed over manually dermabraded recipient site (lip) with the help of a glass slide. An aerosol
48
spray containing polyvinyl polymer, cetrimide and benzocaine (Healex plus® SHREYA LIFE
49
SCIENCES PVT LTD, Mumbai, India) was sprayed from distance of 4½" to 5" over properly
50
positioned graft on lip till it formed a thin film, taking care of the surrounding structures. The
51
graft used to get stuck onto the lip without requiring any further dressing following application
52
of spray (Figure 1). Patients were counseled about post procedure care. Patients were reviewed
53
after 01 week, 01 month and 03 months. Results are shown in Table II and Figures 2A and 2B.
54
At the end 0f 03 months, there was good or excellent repigmentation in all cases subjectively and
55
> 90% repigmentation in all 04 cases. Complications included stuck on appearance and
56
depigmentation of right lateral part of lower lip.
AC C
EP
TE D
M AN U
SC
RI PT
38
ACCEPTED MANUSCRIPT 3
References:
58
1. Bhatia, Riti & Gupta, Somesh. (2018). Surgical Management of Vitiligo of Lips, Eyelids, and
59
Genitals: Medical and Surgical Management. 10.1002/9781118937303.ch42.
AC C
EP
TE D
M AN U
SC
RI PT
57
ACCEPTED MANUSCRIPT 4
Figure legends
61
Figure 1: Lip vitiligo Patient 4, immediately after application of aerosol spray
62
Figure 2A: Lip vitiligo Patient 1, before procedure
63
Figure 2B: Lip vitiligo Patient 1 after 03 months of procedure
Table legends
66
Table I : Demographic profile of the patients
67
Table II: Results
AC C
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M AN U
65
SC
64
RI PT
60
ACCEPTED MANUSCRIPT 5
Table I : Demographic profile of the patients Patient
Age/sex Type of vitiligo
Duration of disease
Stability
1
16/F
Mucosal(Lower lip)
02 yrs
01 yrs
2
20/F
Mucosal (Lower lip)
03 yrs
3
24/M
Mucosal (Upper& lower 12 yrs
RI PT
68
02 yrs
02 yrs
52/M
Non
segmental 03 yrs
(Generalized
including
upper and lower lip) 69
Table II: Results
2 3 4
SSG
Subjective
Objective
Donor
response
response
complications
complications
(At the end of
(At the end of
03 months)
03 months)
Excellent
>90 %
None
Stuck
AC C
1
Graft
TE D
Patient
EP
70
02 yrs
M AN U
4
SC
lip)
site Recipient
site
appearance
SSG
Excellent
>90 %
None
None
SBEG
Good
>90 %
None
None
SBEG
Good
>90 %
None
Koebner’s phenomenon
71
SSG: Split thickness skin graft SBEG: Suction blister epidermal graft
on
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
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