| Aims & Objectives To address the challenge of suspension loss during Non-Cultured Epidermal Cell Suspension (NCES) procedures for stable vitiligo—particularly over convex or sloped surfaces—by evaluating a simple “double-loading” technique that enhances retention of melanocyte suspension on the recipient site. Methods The proposed modification integrates a preloading step into the conventional NCES protocol. A sterile, dry collagen sheet is trimmed to match the size of the recipient site. Melanocyte suspension is uniformly spread onto one surface of the sheet using a 1 mL syringe. The dermabraded recipient area is then covered with an additional layer of suspension before placing the preloaded collagen sheet, ensuring the loaded surface faces downward in direct contact with the suspension-covered skin. The hygroscopic, fibrous, porous, and hydrophilic properties of collagen aid in trapping the suspension and preventing gravitational runoff. Results This double-loading technique demonstrated improved suspension retention on the dermabraded recipient area compared to the traditional approach, which applies the suspension directly onto skin before covering with an unloaded sheet. The modified method minimized loss due to gravitational trickling, ensured uniform distribution of cells, and maintained optimal contact between the suspension and the recipient bed. Anecdotal intraoperative observation indicated better graft stability, particularly in anatomically challenging regions. Conclusions The double-loading technique offers a simple, low-cost, and reproducible modification to conventional NCES, significantly enhancing suspension retention on the recipient site. By leveraging the physical characteristics of collagen sheets, it addresses a common cause of cell loss and has the potential to improve overall graft take and repigmentation outcomes in vitiligo surgery. Further controlled studies are warranted to quantify long-term clinical benefits and assess statistical significance of the observed improvements. References: Huggins RH, Henderson MD, Mulekar SV, Ozog DM, Kerr HA, Jabobsen G, Lim HW, Hamzavi IH. Melanocyte-keratinocyte transplantation procedure in the treatment of vitiligo: the experience of an academic medical center in the United States. J Am Acad Dermatol. 2012 May;66(5):785-93 |
