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Antiseptic tulle gras dressing is an effective approach to applying an ultrathin skin graft template on depigmented areas in recalcitrant vitiligo. This method helps prevent graft displacement and deformity (curling and wrinkling) of its edges.

Recalcitrant vitiligo requires rapid repigmentation. Ultrathin split-thickness skin grafting constitutes an effective surgical treatment of recalcitrant vitiligo. In vitiligo, the ultrathin grafts are characterized by minimal dermal tissue, which is shed after a period of 1–2 weeks following transferring of melanocytes to the skin patch. Since these are fragile, the ultrathin graft may tear upon disproportionate manipulation. The grafts are applied to the dermabraded site on the skin, extending only 2–3 mm beyond, since the extension of grafts into normal skin is associated with risk of displacement.

This study, published in the Journal of Dermatology, Venereology, and Leprology, proposed the use of an antiseptic tulle gras dressing to develop a template corresponding to the size and shape of the recipient ultrathin skin graft. The author outlined the depigmented area along with 2 mm of normal skin with a surgical pen. The investigator traced the marked boundary on the translucent antiseptic tulle. After the removal of the butter paper covering, the investigator placed the graft on the tulle while maintaining contact between the tulle and the epidermal aspect of the graft.

The investigator evenly spreads the graft onto the skin, followed by trimming the graft–dressing composite, along with the outlining done prior. The investigator places the graft–tulle template on the recipient site on the skin, ensuring that the dermal aspect faces the skin. The investigator secures the graft using gauze and Tegaderm following the removal of the outer butter paper covering.

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This study concluded that the graft–tulle template is an efficient method of direct application of the graft on the recipient site. This approach prevents graft displacement, curling, and wrinkling of the edges. Defining the areas corresponding to the graft and recipient prior to the procedure facilitates graft shrinkage, which prevents the formation of a peripheral depigmented halo. The applications of tulle gras dressing in transferring donor tissue include the Jodhpur technique, suction blister grafting, and non-cultured epidermal suspension.

Reference

Sindhuja, T., Chandra, A. D., & Gupta, S. (2022). Ultrathin split-thickness skin graft template using antiseptic tulle gras dressing for vitiligo. Indian Journal of Dermatology, Venereology and Leprology, 1. https://doi.org/10.25259/ijdvl_610_2022