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Breaking the sheet: A simple twist to improve the cell suspension retention in non-cultured epidermal cell suspension using a pixelated collagen dressing
*Corresponding author: Akshay Meena, Department of Dermatology and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. akshaymeena669@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Meena A, Kumar S. Breaking the sheet: A simple twist to improve the cell suspension retention in non-cultured epidermal cell suspension using a pixelated collagen dressing. J Cutan Aesthet Surg. doi: 10.25259/JCAS_258_2025
Abstract
Non-cultured epidermal cell suspension is an established surgical treatment for stable vitiligo; however, optimal retention of the applied cell suspension at the recipient site remains a technical challenge. Conventional use of a single collagen sheet may result in peripheral pooling of cells, uneven repigmentation, and difficulty in dressing anatomically contoured areas. We describe a simple modification wherein the collagen dressing is divided into multiple small, uniformly sized pieces and evenly applied over the dermabraded recipient site. This technique improves uniform cell retention, minimizes pooling, adapts better to irregular surfaces, and facilitates homogeneous and aesthetically favorable repigmentation.
Keywords
Collagen dressing
Non-cultured epidermal cell suspension
Repigmentation
Surgical technique
Vitiligo
PROBLEM STATEMENT
Among the various surgical treatment options available for vitiligo, non-cultured epidermal cell suspension (NCES) is considered the well-stabilized technique both for stable segmental and non-segmental vitiligo. A critical factor influencing the success of this procedure is proper dressing of the dermabraded recipient site following the application of the melanocyte cell suspension. Collagen dressing is essential during the early phase of covering the dermabraded site. Typically, a single sheet of collagen, trimmed to fit the lesion size, is used. However, this approach often leads to pooling of the suspension at the lesion margins, increasing the risk of peri-lesional hyperpigmentation, uneven repigmentation, and run-off. Applying a single collagen sheet poses significant technical challenges on irregular, contoured anatomical sites due to their complex topography and non-planar surfaces.
RECOMMENDED SOLUTION
To address this issue, we propose a simple yet effective modification to the standard collagen dressing technique used in the NCES procedure. Instead of applying a single, large sheet of collagen cut to the shape and size of the lesion, we recommend dividing the collagen into multiple small, uniformly sized pieces (approximately 1 × 1 cm each) [Figure 1]. These smaller segments are then carefully and evenly placed across the entire dermabraded recipient area [Video 1]. The segments adhere firmly to the dermabraded bed through intrinsic adhesion with wound exudate and the applied suspension. Slight edge overlap provides cohesive yet flexible coverage, ensuring stability without compromising contour conformity.
Video 1:
Video 1:Video demonstrating melanocyte cell suspension application using 1 mL tuberculin syringe, followed by applying a 1 × 1 cm collagen dressing with the help of Castroviejo forceps.
- Dermabraded vitiligo patch on the face after application of melanocyte cell suspension and subsequently overlaid with equally divided collagen dressing (pixelated collagen dressing), each measuring 1 × 1 cm, delineated by black marking.
This modification provides several benefits. By segmenting the collagen into smaller pieces, the cell suspension is more evenly retained across the wound surface, significantly minimizing the pooling of cells at the periphery. Consequently, this technique mitigates the risk of perilesional hyperpigmentation, a frequently encountered complication with conventional single-sheet collagen application, and facilitates a more homogeneous and aesthetically favorable repigmentation within the treated area [Figure 2]. Furthermore, this technique affords superior adaptability of the dressing to anatomically irregular lesion contours and potentially augments the graft material’s adherence to the recipient wound bed, thereby enhancing graft stability and optimizing overall therapeutic efficacy.
- Clinical photographs showing the vitiligo lesion on the left cheek at (a) baseline and (b) at 3-month follow-up following treatment with the pixelated collagen dressing technique.
Author contributions:
AM: Conceptualization of the technique, surgical procedure, data acquisition, manuscript drafting, critical revision of the manuscript, literature review, final approval of the version to be published. SK: Surgical assistance, critical revision of the manuscript, literature review, final approval of the version to be published.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.