Key Takeaways
- MKTP is a cellular grafting option for clinically stable vitiligo (no new/enlarging lesions for 6–12 months; negative Koebner).
- Best results on face/neck and trunk; acral and mucosal sites remain challenging.
- Repigmentation can reach 65–90% in selected candidates; post-op NB-UVB improves take and color match.
- Complications are usually minor (transient hyper/hypopigmentation, textural change); scarring is rare with proper technique.
Indications & Stability Criteria
- Nonsegmental or segmental vitiligo with documented stability ≥6–12 months (photos, F-VASI/T-VASI unchanged; no Koebner).
- Failure/plateau after optimized NB-UVB/excimer ± topicals.
- Cosmetically sensitive areas with high impact and adequate donor skin.
- Exclude active inflammatory edges, keloid diathesis, poor wound healing, pregnancy, uncontrolled comorbidities.
Surgical Workflow
Table 1. MKTP steps (high-level).
| Phase |
Step |
Notes |
| Planning |
Mapping with Wood’s lamp; mark stable borders |
Standardized photography, consent |
| Donor |
Split-thickness superficial dermabrasion (thigh/hip) |
Harvest ~1:5–1:10 donor:recipient ratio |
| Recipient |
Superficial dermabrasion to pinpoint bleeding |
Atraumatic, uniform depth |
| Application |
Spread cell suspension evenly; cover with dressing |
Avoid pooling; even film |
| Immobilization |
Non-adherent + bolster/occlusion |
Immobilize 5–7 days |
Cell Processing (Overview)
- Trypsinization of epidermal sheet → melanocyte–keratinocyte suspension in buffered medium.
- Optional additives (e.g., hyaluronic acid) to improve spread/adhesion.
- Maintain sterility; temperature control; gentle handling to preserve viability.
Post-operative Care & Phototherapy
- Immobilize graft; protect from shear/pressure for 7–10 days.
- Start NB-UVB 10–14 days post-op if epithelialized; 2–3×/week for 8–12 weeks.
- Emollients; avoid topical irritants on graft early; sun protection to prevent color mismatch.
Outcomes by Site
Table 2. Typical repigmentation gradients.
| Site |
Repigmentation |
Notes |
| Face/neck |
High (70–90%) |
Excellent color match |
| Trunk/limbs (non-acral) |
Moderate–high |
Edges blend well with NB-UVB |
| Acral (hands/feet) |
Lower |
Consider staged/adjunct excimer |
| Lips/mucosa |
Variable |
Technique-dependent |
Complications & Risk Management
- Color mismatch (hyper/hypopigmentation): titrate post-op NB-UVB; camouflage interim.
- Textural change or milia: usually transient; gentle skincare.
- Donor site: PIH; minimize depth, strict photoprotection.
- Infection/poor take rare with sterile technique and fixation.
Tables (framework)
Table 3. Outcome metrics to populate.
| Metric |
Value |
Comment |
| Repigmentation ≥75% (n, %) |
— |
Primary success threshold |
| Time to visible pigment (weeks) |
— |
Typically 4–8 |
| Relapse at 12 months (n, %) |
— |
Lower with maintenance NB-UVB |
| Complication rate (overall %) |
— |
Grade and management |
Limitations
Operator-dependent results; heterogeneous protocols; patient selection critical; fewer controlled head-to-head trials vs medical therapy; resource/skill requirements limit access.
References
- Prospective/retrospective series of MKTP in stable vitiligo reporting site-specific outcomes and durability.
- Method papers on cell suspension preparation and graft fixation techniques.
- Studies on post-operative NB-UVB to enhance take and color matching.