JDA SST 흉터치료

아래 내용은 SST를 이용한 흉터치료 관련해서 JDA에 게재 된 논문 내용입니다.

유레카피부과 김동석원장이 직접 개발한 SST피부이식술을 이용한 흉터치료는 흉터치료의 새로운 패러다임으로 자리잡게 될 것입니다.

[ 유레카피부과에서 치료받은 환자 케이스입니다. ]

ORIGINAL ARTICLE

ABSTRACT

1 | INTRODUCTION

2 | METHODS

2.1 | Study participants

This was a retrospective study to evaluate the treatment effects of micropunch grafting for hypopigmented scars. The study cohort consisted of 21 subjects with hypopigmented scars on the face and neck, selected through a thorough retrospective review of medi- cal records. Study participants included individuals who had not responded satisfactorily to conventional scar treatments such as topical medications, laser therapy, or surgical interventions, and who had finally undergone grafting for scar repigmentation. All cases in- cluded in this study were those who had not been diagnosed with vitiligo, either in the past or at the time of surgery (Table 1).
TABLE 1 Demographic and clinical characteristics of the study participants.

Number of participants	21
Sex, n (%)
Male	4 (19.0)
Female	17 (81.0)
Age distribution, n(%)
<30	9 (42.9)
30–50	10 (47.6)
>50	2 (9.5)
Diagnosis, n (%)
Wound suture scar	4 (19.0)
Burn scar	4 (19.0)
Acne scar	2 (9.5)
Laser scar	4 (19.0)
Plastic surgery scar	7 (33.5)
Fitzpatrick skin type, n (%)
III	14 (66.7)
IV	7(33.3)

2.2 | Data collection

The retrospective data collection process involved a meticulous review of subjects' medical records, encompassing preoperative evaluations, procedural details, postoperative outcomes, and fol- low-up assessments. Key variables of interest included the extent of hypopigmented scarring, subjects’ demographics, characteris- tics of the donor and recipient sites, and any documented adverse effects.

2.3 | Intervention: Motorized micropunch grafting with a skin-seeding technique

The skin-seeding technique involves transplantation of full-thickness skin, consisting of melanocytes and melanin pigment obtained from a pigmented donor area, to the hypopigmented scarring site. The surgical procedure was identical to that reported in a previous study.5,6 The donor and recipient sites were harvested using a mo- torized 0.4-mm micropunch (i-graft; Ilooda) and were grafted onto the hypopigmented scarring site (Figure 1).

2.4 | Outcome measures

The primary outcome measure was the degree of scar repig- mentation. The repigmentation rate was assessed through a photograph evaluation using a physician's 4-point repigmenta- tion global assessment a scale: mild, 0–25%; moderate, 26–50%; good, 51–75%, and excellent to complete, 76–100% repigmenta- tion.7,8 Secondary outcome measures included the occurrence of any adverse effects such as infection, bleeding, or other surgical complications.

2.5 | Ethical considerations

This study adhered to ethical guidelines and obtained approval from the institutional review board of Ajou University Hospital (IRB num- ber: AJOUIRB-DB-2023-610). Informed consent was obtained from all patients involved in the study.

3 | RESULTS

3.1 | Patient demographics and clinical characteristics

The study cohort comprised individuals who exhibited hypopigmented scarring patches, predominantly as a consequence of plastic surgery (n = 7), specifically epicanthoplasty (Table 1). Others included those with a wound suture scar (n = 4), burn scarring (n = 4), acne scarring



FIGURE2 Representative photographs of micropunch grafting treatments for various hypopigmented scars. (a) Suture scar on the right forehead of a 23-year-old female, (b) acne scar on the nose of a 31-year-old female, (c) alar resection scar on the philtrum of a 31-year-old female, and (d) epicanthoplasty scar on the philtrum of a 29-year-old female.
(n = 2), and ablative laser scarring (n = 4). The distribution of hypopig- mented scars was consistently observed on the face or neck in all sub- jects. Participants had undergone prior treatments, encompassing a range of conventional modalities such as topical medications (n = 14), chemical peels (n = 2), laser therapy (n = 10), and micro-needling (n = 4).

3.2 | Repigmentation of hypopigmented scars

All 21 subjects exhibited excellent to complete repigmentation, of more than 75% repigmentation of the hypopigmented scars. Outcomes of more than 90% repigmentation were observed in 17 subjects (Figure 2). The mean duration until subjects experienced clinical improvement to the extent that they no longer felt the need for further treatment was 5.5 months. No case of recurrence was observed during the follow-up period of up to 2 years post grafting.

3.3 | Adverse effects

No adverse effects, such as infection, active bleeding, or other sur- gical complications, were reported. Transient erythema and subtle differences in skin height were observed immediately after grafting. These minor effects resolved over time and became indistinguish- able later.

4 | DISCUSSION

The present study demonstrated the efficacy and safety of micro- punch grafting with SST for the repigmentation of hypopigmented scars. Remarkable success was observed in all 21 subjects, and particularly noteworthy is the achievement of more than 90% re- pigmentation in 17 subjects. The mean duration of 5.5 months for improvements that satisfied the subjects was within a reasonable timeframe, offering practical insight into the expected timeline for scar disappearance following grafting. The absence of recur- rence during the 2-year follow-up period is a pivotal finding, con- tributing to the overall positive outlook on the long-term efficacy of micropunch grafting. The sustained benefits observed over an extended period endorse micropunch grafting as a durable and reli- able intervention for the repigmentation of hypopigmented scars. Encouragingly, the study revealed a lack of adverse effects, empha- sizing the procedure's safety and its potential for integration into routine clinical practice. The molecular and biological mechanisms of repigmentation in hypopigmented scars involve the transfer of melanocytes from the donor area, leading to melanocyte migration and melanogenic ac- tivation at the recipient site. A previous histopathological analysis of the procedure observed that transplanting tissue from a donor area onto vitiligo lesions resulted in the presence of melanocytes in the basal layer that were not originally present, along with their proliferation.6 While there may be differences in the immune status or mesenchymal environment between hypopigmented scar tissue and vitiligo, it is plausible that a similar mechanism may contribute to the therapeutic effects. It has been shown that split-skin grafts achieve good results in regard to the pigmentation of hypopigmented scars.9–11 However, the two limiting factors associated with these types of conventional skin grafting are that they are both painful and time-consuming.12 Motorized micropunch grafting with SST has been proposed as a promising option to treat hypopigmented lesions of refractory vitil- igo.5,6,13 The use of a motorized punch promises better efficacy due to it being an easier and faster procedure with less pain compared to conventional grafting.13 Furthermore, a punch with a small diameter of 0.4 mm resulted in a minimal wound size, reducing the potential for a cobblestone appearance.6,13 This approach also offers better compli- ance for children with vitiligo.13 Given our results, micropunch grafting with SST can be regarded as a promising alternative for patients with hypopigmented scars resistant to conventional treatments. A limitation of this study is its small sample size and the restricted lesional sites considered (face and neck), which may limit any gener- alization of the effectiveness of SST in the treatment of all areas of hypopigmented scarring. In summary, motorized micropunch grafting with SST is an effec- tive and promising alternative treatment for the repigmentation of hypopigmented scars. Further research with a larger sample size and controlled trials is needed.

CONFLICT OF INTEREST STATEMENT

None declared.

INFORMED CONSENT

Informed consent was obtained from all patients involved in the study.

IRB REVIEW

This study was approved by the institutional review board of Ajou University Hospital (IRB number: AJOUIRB-DB-2023-610).

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