Dermatologic surgery Syringes versus Chinese cups in harvesting suction-induced blister graft: a randomized split-body study Tag S. Anbar 1 , MD , Nayera H. Moftah 2 , MD, Mohammad A.M. El-Khayyat 1 , MD, Hasan M. El-Fakahany 1 , MD, Amal T. Abdel-Rahman 1 , MD, and Enas K. Saad 3 , MSc 1 Department of Dermatology, STD’s and Andrology, Minia University, Minia, Egypt, 2 Dermatology and Venereology Department, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt, and 3 Department of Dermatology, STD’s and Andrology, Matay Central Hospital, Minia, Egypt Correspondence Tag S. Anbar, MD Department of Dermatology, STD’s and Andrology Minia University Second Floor, 9 Hamadan Street Giza Egypt E-mail: taganbar@yahoo.com Conflict of interest: None declared. doi: 10.1111/ijd.14040 Abstract Background Suction blister grafting (SBG) is a technique where the pigmented epidermis is harvested from the donor site by induction of a blister using different suction methods as syringes, Chinese cups, suction device, etc. However, pain, time consumption, incomplete blister formation, and failure of blister development are the main limitations. Objective To compare between cups and syringes of similar diameter in inducing suction blisters. Patients and methods In 30 patients with stable nonsegmental vitiligo, 2-cm-diameter (20 ml) syringe was applied on the anterolateral aspect of one thigh and a 2-cm-diameter cup on the corresponding site of the other thigh where right and left sides were chosen randomly. Patients were observed untill complete blister development or for a maximum of 3 hours. Suction blister induction time (SBIT) and the blister diameter were recorded for each patient. Pain during the process of induction was evaluated. Results Incomplete blister development was noted in 9 out of 30 (30%) with 2 cm syringes and 6 out of 30 (20%) with the similar diameter cups with no significant difference (P = 0.49). No significant difference was found between SBIT induced by the 2 cm syringes and the similar size cups (101.17 Æ 68.14 minutes, 98 Æ 56.84 minutes, respectively) (P = 0.85). Meanwhile, blister diameter induced by either syringe or cup was not significantly different (P = 0.37). Anesthesia was for short duration with xylocaine, and pain was intolerable in both sides in the first seven patients. A combination of xylocaine and bupivacaine was used with prolonged loss of pain in 17 of the remaining 23 patients and tolerable pain in six patients similarly in both sides. Conclusion According to present results, the differences in SIBT, diameter of blisters, and number of complete blister formation induced by either syringes or cups of similar size were not significant. Therefore, whatever the available and feasible technique for the surgeon will be the ideal choice. A combination of xylocaine and bupivacaine is recommended to overcome the accompanying pain of the procedure. Introduction Suction blister grafting is a technique where the pigmented epi- dermis is harvested from the donor site by using suction to raise a blister which is then transferred to the vitiliginous area. Cleav- age occurs between the basal cells and the basal lamina of the basement membrane zone, and only the epidermal portion of the donor area is grafted. 1 Blisters may be raised using syringes, suction pump, or suc- tion cups. 2 Suction blister grafting is a technique that has proved to be relatively safe, inexpensive, not difficult, and offers a high mean success rate in vitiligo treatment with no scarring at the donor area. 3 It is worthy to mention that this easy method of obtaining such epithelial layers may also be useful in many other dermatologic conditions to cover raw areas to enhance healing or to repigment leukoderma of other causes. 4 On the other hand, it is time consuming and requires specific attention, as epidermal grafting is very easy to tear and to roll up. Incom- plete blister or failure of blistering may also occur. 3 In various studies, the reported time for suction blistering var- ies widely from 15 minutes to more than 3 hours depending on various factors. The site of the suction blister, the subject’s age, amount of vacuum created, temperature, intradermal injection of saline, corticosteroid-induced atrophy, and pretreatment of the site with PUVA are important factors that influence the suc- tion blister induction time (SBIT). 5 Diameter of the syringe or cup is also among these factors where SBIT increases with increase in their diameters. 4,5 However, to our knowledge, ª 2018 The International Society of Dermatology International Journal of Dermatology 2018 1