Inexpensive Incubator for Autologous Melanocyte-keratinocyte Transplantation Surgery in Vitiligo

Therapeutic Problem Non-cultured autologous melanocyte keratinocyte cell transplantation (NCMKCT) procedure has proved to be a boon for treating patients with localized stable vitiligo patches. Preparing the cell suspension in NCMKCT involves incubating the split-thickness skin grafts soaked in 0.25% w/v trypsin solution in an incubator from 45 to 60 min with temperatures maintained at 32–40 degrees Celsius.[1] This is thought to be important for trypsin activation and subsequent separation of the epidermis from the dermis. However, conventional incubators are expensive, space-occupying, and additional investment for a dermatosurgeon. Solution Aljasser et al.[2] studied trypsinization of epithelium under various temperature conditions and concluded that the epidermis separated from the dermis at room temperature in an air-conditioned room without using an incubator. Although these findings await larger sample size validation, the authors thought of using a cost-effective simple incubator in the form of an autoclaved stainless steel box covered with sterile autoclaved surgical drapes to keep the split-thickness graft for trypsinization. India lies in the tropical-subtropical belt with the standard room temperature typically around 25 to 35 degree Celsius. The temperature attained in the autoclaved box was measured with a digital thermometer sensor wired for room temperature [Figure 1]. The authors have been using this autoclaved steel box as an incubator for more than a decade. Consistent good re-pigmentation without any adverse effects has been achieved in all treated patients. The authors are aware that this modification may not work in all scenarios as India is a vast country with diverse climatic zones, so actual room temperature may vary significantly depending on the region and the time of the year. However, this inexpensive and effective modification can be tried to enable the NKMCT procedure, giving gratifying re-pigmentation in patients of vitiligo even in resource-deficient settings.Figure 1: (a) Split-thickness skin graft soaked in 0.25% w/v trypsin solution. (b) Donor graft placed inside a stainless steel autoclaved box. (c) Digital thermometer measuring temperature within the autoclaved steel box. (d) Surgical drapes covering the steel box incubated for 45-60 minutesFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.