Verteporfin: Scarless healing

Edit Post

There is a relatively old drug which is being trialed for scarless healing. It has had positive trials in mice, and I believe they're working on pigs currently (whose skin is similar to humans)

https://med.stanford.edu/news/all-news/2021/04/drug-enables-healing-without-scarring.html

This could be a relatively large development in limb lengthening. The obvious use for this is with scarless healing of the surgical incisions. But another angle is that this can be used to promote scarless healing of your soft tissues such as your muscles/tendons etc (especially if they're perfoming an IT band release). Scars in soft tissues are one reason for lowered athletic ability and function in limb lengtheners.

Edit Post

Quote from: MakeMeTallAF on July 18, 2021, 07:57:57 PMThere is a relatively old drug which is being trialed for scarless healing. It has had positive trials in mice, and I believe they're working on pigs currently (whose skin is similar to humans)

https://med.stanford.edu/news/all-news/2021/04/drug-enables-healing-without-scarring.html

This could be a relatively large development in limb lengthening. The obvious use for this is with scarless healing of the surgical incisions. But another angle is that this can be used to promote scarless healing of your soft tissues such as your muscles/tendons etc (especially if they're perfoming an IT band release). Scars in soft tissues are one reason for lowered athletic ability and function in limb lengtheners.

If it works with LL then it should work with all the major cosmetic surgeries correct?

Edit Post

It should work with any surgery, and any injury that produces scars (but the drug has to be administered before the wound heals)

Theoretically though if a scar forms, I think you should be able to surgically remove the scar and then apply verteporfin and it will heal without scarring. Not sure how this would work in vivo but it's possible those who already have scars from LL can go and get this done retroactively.

Edit Post

It is indeed a promising field of research, however it is unlikely to arrive to LL soon because...

1) Normal skin has fibroblast cells that lay collagen in a complex lattice form. During scarring, the same cells lay collagen in a simple parallel form. This is faster, and allows blood to clot quickly. As with any major operation, during LL, significant blood loss occurs, and scarring is essential for you to stop losing more blood and prevent infection. You're going to have to apply mechanical force and wait weeks for your incisions to close with Verteporfin, which is simply not feasible after a major blood-losing surgery. It may be possible to do this as a follow-up cosmetic procedure, but that really isn't a LL surgeon's job or specialty.

2) There is no scarring of your soft tissues during LL. Nerves and muscles are not touched. Only bones, skin, and ITB are damaged. Your bones and ITB will regenerate with identical tissues eventually, so no permanent scarring. Your muscles and tendons need to be stretched, which merely realigns existing fibers, so no scarring. Unless you injured yourself during LL, there should be no scarring except for the skin.

Edit Post

You make a good point, with major surgery like LL it may not be possible to use this drug as it blocks the cells from sensing mechanical stress. It may be a situation where a surgeon (probably plastic not orthopedic) would have to go back and reopen the scars and then apply verteporfin - that is if this is even possible in vivo. 

However I disagree that there is no scarring of the soft tissues. For example stretch marks form when your skin stretches too fast for it to grow, which is a form of scarring. And when the incisions are made to insert the rod and to break the bone, there will be inevitable scarring of any soft tissues they have to go through. If you do externals there will obviously be lots of scarring especially where the pins attach. You can't treat these during lengthening but with this as well it may be a retroactive procedure.

As for the ITB, when they release the ITB I imagine it doesn't heal without any degree of scarring. You cannot compare bone to tendons, as bones don't scar when healing whereas tendons/muscles/nerves all do.

Edit Post

Quote from: MakeMeTallAF on July 19, 2021, 03:39:53 AMYou make a good point, with major surgery like LL it may not be possible to use this drug as it blocks the cells from sensing mechanical stress. It may be a situation where a surgeon (probably plastic not orthopedic) would have to go back and reopen the scars and then apply verteporfin - that is if this is even possible in vivo. 

However I disagree that there is no scarring of the soft tissues. For example stretch marks form when your skin stretches too fast for it to grow, which is a form of scarring. And when the incisions are made to insert the rod and to break the bone, there will be inevitable scarring of any soft tissues they have to go through. If you do externals there will obviously be lots of scarring especially where the pins attach. You can't treat these during lengthening but with this as well it may be a retroactive procedure.

As for the ITB, when they release the ITB I imagine it doesn't heal without any degree of scarring. You cannot compare bone to tendons, as bones don't scar when healing whereas tendons/muscles/nerves all do.

So

1) Stretch marks are again skin scars, which face the same fibroblast problems previously discussed. The muscle and fat tissues underneath do not undergo scarring when the individual loses weight.

2) I can't speak for external fixiators, but during my internal Betzbone implant, no muscles or nerves were touched. Muscles are lateral fibers that can be pulled apart during screw insertion and released back to their original position afterwards. Nerves and tendons are not touched. I did not lose any function immediately after my procedure except for pain from the surface skin wounds, only general weakness expected from operational trauma. I definitely would have felt it, had I scarred anywhere else.

3) I had my ITB released 3 weeks ago. The ITB is not a tendon but a fascae and will of course first scar. However, during the remodelling process like bones, it will be replaced with identical fiborous tissues. The regenerated ITB will be indifferentiable from the original.

Most long-term impairment from LL patients I've talked to mainly derive from losses in flexibility in ITB and hip flexors, as hamstrings and quads are very responsive to stretching. The losses in flexibility are not due to scarring, but age, starting flexibility, and effort.

Edit Post

Based on this video by Rozbruch, I feel like there will be damage done to the soft tissues during the procedure itself because they literally drill through your leg for the osteotomy. That will of course produce scarring as those tissues heal.

In fact the reason so many patients experience permanent knee pain when doing internal tibias is because they drill through the patellar tendon to insert the nail I believe (which heals by scarring) and never recovers 100%. I believe for femoral lengthening when they drill into the femur they don't go through any tendons which is why there generally isn't long term hip pain.

As for the ITB, if it is regenerated without scarring, I'm not sure why there would be losses in flexibility. Is there even a process of natural scar reversal in humans?

Edit Post

Quote from: MakeMeTallAF on July 19, 2021, 07:22:35 PM

Based on this video by Rozbruch, I feel like there will be damage done to the soft tissues during the procedure itself because they literally drill through your leg for the osteotomy. That will of course produce scarring as those tissues heal.

In fact the reason so many patients experience permanent knee pain when doing internal tibias is because they drill through the patellar tendon to insert the nail I believe (which heals by scarring) and never recovers 100%. I believe for femoral lengthening when they drill into the femur they don't go through any tendons which is why there generally isn't long term hip pain.

As for the ITB, if it is regenerated without scarring, I'm not sure why there would be losses in flexibility. Is there even a process of natural scar reversal in humans?

Again, I cannot speak for tibias or externals since I did femur with internal nails.

As with a drill, my bones were sawed clean. After the skin incision, muscles and tendons in the femur were pulled apart like a curtain and released to their original position after the osteotomy is complete.

The ITB does scar, but the scar tissue is replaced with identical tissues to its surrounding afterwards. This is because fascae are simple fiborous tissues, not too much more complex than the scar tissues they are replacing. Your skin has pain nerves, sweat glands and blood vessels interwoven throughout. Scars do not have any of those functionalities, hence why skin scars are so much harder to recover.

Because your ITB is not a tendon or muscle, it is not very responsive to stretching or elongation. As you lengthen, your band will become short in contrast, limiting your mobility. It's the muscles nearby that will stretch, hence why the band is cut during lengthening for patients.

Edit Post

Quote from: SirStretchAlot on July 20, 2021, 07:41:12 AM

As with a drill, my bones were sawed clean. After the skin incision, muscles and tendons in the femur were pulled apart like a curtain and released to their original position after the osteotomy is complete.

Ah ok that is good to hear. In that case it should minimize the damage done during the osteotomy.

As for the ITB, Rozbruch in his interview with Cyborg said it grows along with the bone, that's why they perform the ITB release.

So I'm still confused as to why the ITB is causing a loss of flexibility.

Edit Post

Quote from: MakeMeTallAF on July 20, 2021, 08:53:08 PMAh ok that is good to hear. In that case it should minimize the damage done during the osteotomy.

As for the ITB, Rozbruch in his interview with Cyborg said it grows along with the bone, that's why they perform the ITB release.

So I'm still confused as to why the ITB is causing a loss of flexibility.

The ITB consists of fiborous, not elastic tissues as with muscles and tendons. It does not flex or contract, thus damage and repair is the only way to stimulate growth, like with bones. If your bone lengthens, and the band doesn't, the band will cause your legs to abduct to compensate for the length difference between your femur and ITB. This is known as wide legs.

An ITB release essentially severs the band near the knees where it's the thickest. This alleviates a lot of tension throughout the entire band, allowing stretching to become more effective and damage/repair/lengthen a greater cross-section of the band.