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Innovative slit lip dressing for optimal blister graft success in vitiligo
*Corresponding author: Dr Varsha M Shetty, Associate Professor, Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India. varshams18@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Noronha MF, Potula A, Rao R, Shetty VM. Innovative slit lip dressing for optimal blister graft success in vitiligo. J Cutan Aesthet Surg. doi: 10.25259/JCAS_92_2024
Abstract
Suction blister grafting has proven to be a successful surgical modality in treating vitiligo over sites such as lips, eyelids, and face. The dressing over the recipient area plays a crucial role in determining the outcome of the procedure. Therefore, we propose a novel method to dress the upper and lower lip following blister grafting using a slit in an adhesive transparent dressing.
Keywords
Blister grafting
Dressing
Lip
Surgery
Vitiligo
PROBLEM STATEMENT
The lip is considered one of the difficult sites to perform vitiligo surgery due to the difficulty in applying a dressing that adheres to the mucosa and holds the graft in place while permitting the patient to eat and talk. This technique circumvents the need for mucosal adhesion.
RECOMMENDED SOLUTION
The blister graft harvested from the upper thigh is placed over the dermabraded areas on the upper and lower lip, secured with surgical glue, and covered with a four-layer dressing. The first three layers, comprising of paraffin gauze, saline-soaked gauze, and dry gauze from within outward, are applied over the lower lip in the smiley face direction and on the upper lip in the sad face direction and secured with an adhesive crepe bandage just beyond the angle of the mouth [Figure 1]. The patient is asked to part lips and an adhesive transparent dressing is placed over it after which a linear slit is made over the mouth opening, thus making the dressing water-proof [Figure 2]. The patient can consume small morsels of food with a teaspoon, sip with a boba straw, and communicate. This prevents the patient from opening the mouth too wide, which might dislodge the graft. Previous methods to hold the dressing in place include stay sutures, surgical tape, plastic splints, and dental putty which are cumbersome and uncomfortable for the patient.1-3 Thus, this novel dressing proposed not only provides support and immobilizes the graft but also forms a protective barrier and allows for some essential lip movements enabling the patient to eat and talk. In addition, it allows us to perform the surgery on the upper and lower lip simultaneously, thus saving both surgical and recovery time for the patient. It also saves the extra resources that are otherwise needed to complete this treatment in two different settings.
- Three layered dressings applied over the lower lip in the smiley face direction and on the upper lip in the sad face direction and secured with an adhesive crepe bandage just beyond the angle of the mouth. A linear slit is being made over the adhesive transparent dressing.
- The finished look after making the slit over the oral aperture which allows the patient to do the bare minimum lip movements to eat and talk.
Authors’ contributions
Mihika Faye Noronha: Concepts, design, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing. Anusha Potula: Concepts, design, clinical studies, experimental studies, manuscript editing, manuscript review. Raghavendra Rao: Concepts, design, clinical studies, experimental studies, manuscript editing, manuscript review. Varsha M. Shetty: Concepts, design, definition of intellectual content, literature search, clinical studies, experimental studies, statistical analysis, manuscript preparation, manuscript editing, manuscript review, guarantor.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
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.
References
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