From Dr Bloxham Discord:
”Alright, so I think I've finally caught up after the verteporfin trial and wanted to sort of unpack and just share my initial thoughts -- which I thought may be useful/interesting. So, just to recap, I did 3 separate patients, removing 1cm x 2.5cm mini-strips and directly treated (direct dermal injection with the wound open) the areas with 0.4mg/cm^2 up to 0.8mg/cm^2 verteporfin. First, I must say that the trial was a blast! It was stressful and exhausting (I recalculated and realized I was actually at the office for 16 hours straight, and not 19, but you get the point!), but truly exciting. Second, having the 4 hour window to use the reconstituted verteporfin is a bit stressful when you are dealing with multiple patients. It seems like a long time, but I was down to the wire. I had it quite well coordinated too - where I basically had it lined up so I could do all three of the excisions portions back-to-back (opposed to taking tissue and then making incisions and then placing the dissected tissue like in normal FUT) - but I still used pretty much the full 4 hours. Do I think it still would have been good after 4 hours? Yes. But I was trying to reduce variables. Reconstituing the verteporfin and preparing it in the dark room wasn't as difficult as I anticipated. So that was good. However, injecting it was challenging -- which did not surprise me too much. First, the suspension is VERY dark. Thankfully it's still translucent so you can see through it a bit, but very different from saline, lidocaine, etc -- which are all clear. This is compounded by the fact that you need to inject very small and very precise amounts. Which brings me to the actual injecting: I think injecting the first section on the first patient is something I will always remember. Again, just one of those very exciting moments for those who love science. Continued in the next post ...
It's challenging to get the needle right into the dermis where you want. Very easy to go a little too far towards the deeper tissue and end up in the hypodermis or be too superficial and just get a lot of leaking of the verteporfin. Injecting is hard too because you need to pay attention to both where the needle is located and the volume at which you are injecting. So you're sort of looking back and forth rapidly -- checking the volume you are injecting and making sure the needle is in the right spot. In the future, I will probably have a spotter watch the volume for me and tell me when to stop. It would also be possible to have the correct volume in separate syringes, but then you would have dozens and dozes of these. Next, injecting the solution itself is physically hard. It's very thick and takes some real pressure to get through the needle. This is also compounded by a very fine needle (30 gauge) and a dermal injection -- the dermis is hard and injecting into it is always a little more challenging. I did try different gauge needles (27 gauge to be specific), but I'm not sure how much difference it made. I also found it variable between different patients; some had harder dermis tissue compared to others. And compound all of this with no surgical light too -- but I'll get more into that in a moment. I also found varying degrees of extravasation -- verteporfin leaking out of the injection sites. I had one patient who was bleeding more than average and had thinner blood, and he, understandably, had a bit more extravasation. I had others where the injections were super smooth: clearly in the right area, the right volumes, with very little leaking. It's also extremely cool watching the verteporfin sort of collect in the tissues because it has a very characteristic dark green color. I think we did very well with the light. I didn't use the surgical light for any aspect of the removal, injection, or closure. Continued in next post ...
"I found that using magnification (7x, which I use when making recipient incisions) made up for this and I was able to visualize everything well. All of the patients responded well to the medication. No allergic reactions, no irritation reactions (apparently a pretty common one when verteporfin injection sites are exposed to intense light too soon), or anything like that. We kept everything covered well and there were no issues with the donor areas the entire day. Surgeries were unremarkable otherwise. The verteporfin treated sites looked really good at the end of the day. Even a little cleaner compared to the non-treated areas. No other real observations that early. I had them all stay pretty well covered and out of the light for 5 days. I followed up with them closely and saw them back at the office multiple times since the test and everything is great without any issues. So I feel very good about the safely profile of the verteporfin (which was pretty well established regardless). There also did not seem to be any problem going up to nearly double the dose used in tests thus far (0.8mg/cm^2). I spoke about this with several knowledgeable colleagues (including Dr Barghouthi) and felt good about it -- and it seems like that hunch was correct. We will see if it makes a difference with regard to healing. So, altogether, I felt quite good with the first trial and I want to do more regardless of outcome. I think I can definitely do better on subsequent rounds (the first time at anything is obviously always never quite as smooth!). I also want to test the other aspects of verteporfin as well. Next tests will probably be a bigger punch left open to see how it heals/check for regeneration, and then I would love to do some wounding with dermarolling or something like that in the recipient area and then treat with verteporfin to see how it does. Last post below ...
I wanted to, again, thank everyone on the server. You guys have been great! I also would love to be included on any other sites, forums, apps, etc where you share future treatment information. I'm always impressed on how quickly you guys find this new stuff! Any other thoughts on where else I should share this? I know there have been some threads on hair restoraiton network. It looks like it's kind of the last forum standing? Hair Loss Talk previously had all the "future" treatment discussion, but I think that one is gone now! I'm going to document everything through YouTube as well. I'll make the announcement video this week and then update with 48 hour pictures, staple removal pictures, etc. And, of course, I will keep this server the most updated and share everything here first."