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Double-loading technique for improved suspension retention on the recipient site in non-cultured epidermal cell suspension (NCES)
Corresponding author: Dr. Sheetanshu Kumar, Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. kumar.sheetanshu@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Sai Gajula A, Kumar S, Meena A, Ramassamy S. Double-loading technique for improved suspension retention on the recipient site in non-cultured epidermal cell suspension (NCES). Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_1099_2025
Problem
Non-cultured epidermal cell suspension (NCES) is a well-established surgical modality for stable vitiligo. Traditionally, it involves applying the cell suspension over a dermabraded recipient site and immediately covering it with a dry, unloaded collagen sheet to secure the graft.1 However, a frequent challenge, especially over convex or sloped surfaces, is the rapid gravitational trickling of the suspension, leading to its loss before it can be adequately sealed, thus compromising efficacy.
Solution
To overcome this, we propose a simple yet effective modification that combines the classical approach with a pre-loading step. A sterile, dry collagen sheet is trimmed to match the recipient site [Video 1]. The melanocyte suspension is loaded [Figure 1] and then uniformly spread on one of the surfaces of the collagen sheet with the help of a 1 mL syringe. Additional suspension is applied to the recipient area, followed by immediate placement of the preloaded collagen sheet with the suspension-loaded surface facing downwards, ensuring direct contact between the suspension-loaded collagen surface and the suspension-covered dermabraded skin [Figure 2]. Minor edge curling, when it occurs, can be smoothened by gently pulling the edges outward with jeweller’s forceps. For additional ease of handling, the sheet may be placed on the flat surface of a sterile gloved palm, the suspension spread evenly and then transferred onto the dermabraded site by inverting the palm. The collagen sheet retains the preloaded suspension more effectively due to its hygroscopic nature, fibrous texture, porosity, and hydrophilic character, allowing the sheet to hold the suspension in place. In contrast, dermabraded skin, being wet and relatively smooth, lacks these qualities, leading to suspension loss due to gravitational runoff. This double-loading technique, which ensures direct contact between the suspension-loaded undersurface of collagen and the suspension-covered dermabraded skin, enhances suspension retention on the recipient site, thus improving the outcome [Figure 3].
- Loading of melanocyte suspension onto the collagen sheet (this will be followed by uniform spreading of suspension on the collagen sheet).
- Recipient area after placement of the preloaded collagen sheet with the suspension-loaded surface facing downwards, ensuring direct contact between the suspension-loaded collagen surface and the suspension-covered dermabraded skin.
- Follow-up images at 10 weeks post-procedure demonstrating around 75% repigmentation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
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.
References
- 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;66:785-93.
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