Electron microscopy of nuclear degeneration in keratinocytes in suction blister roof grafting.

Dear Editors, Suction blister roof grafting, a method of grafting the epidermis, has been used in the treatment of vitiligo and skin ulcers. Despite damage to keratinocytes and cell death during the suction procedure, application of suction blister roof to wounds appears to aid wound healing, possibly because of the production of cytokines such as TGF-α, PDGF, bFGF, VEGF, IL-1 and IL-6 (1). In order to investigate how keratinocytes in the suction blister roof contribute to epithelialisation of the grafted area, we examined the condition of the cell nucleus of epidermal keratinocytes in suction blister roof using electron microscopy. In this study, suction blister roof grafting was performed in four patients (three females and one male; mean age, 68 years; age range, 30–87 years), and seven samples were obtained. Local anaesthesia was introduced directly into the dermis (2), and 10 ml disposable plastic syringes were used with the piston pulled to a height of 6·5 cm (3). If the patient experienced pain, the piston was lowered until no pain was felt. Consistent with a past report on suction blisters, a plane of cleavage was commonly observed between the basement membrane and the basal layer of keratinocytes on electron microscopy (Figure 1A) (4). Furthermore, nuclear degeneration in keratinocytes in the suction blisters was examined