Tangshan and Beijing, People's Republic of China From the Tangshan Worker's Hospital, Hebei Medical University; Beijing Hospital, Chinese Ministry of Health; Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science; and No. 2 Hospital affiliated to General Hospital of the Chinese People's Liberation Army.
Plast Reconstr Surg. 2009 Nov;124(5):1450-1457. doi: 10.1097/PRS.0b013e3181b989be.
Although the use of the expanded myocutaneous flap has many advantages, the time course is prolonged. The net gain in surface area during acute expansion is insufficient. In this study, botulinum toxin type A was applied to shorten the flap expansion period while obtaining an adequate surface area that would meet surgical requirements.
Seven minipigs were used for the authors' experiments. Two sides of the dorsolumbar section in each pig were divided randomly into the botulinum toxin type A-treated and the saline-treated groups. Two 200-ml expanders were implanted in the submuscular pocket. Inflation began 2 weeks later, and the period of expansion was observed in a double-blind manner. Two weeks after the final inflation, the expansion area was measured, and a 10 x 6-cm myocutaneous flap was elevated and sutured in situ, and the contraction of the myocutaneous flap was observed.
Botulinum toxin type A shortened the expansion time by 17 days (p < 0.001). The average increment of effective expansion area (p = 0.009) and the average recruitment area (p = 0.001) in the botulinum toxin type A-treated group were significantly higher than in the saline-treated group. Moreover, contraction in axial length and width of the botulinum toxin type A-treated group was lower than that of the saline-treated group at each time point following transposition (p < 0.001).
Botulinum toxin type A could decrease the resistance to myocutaneous flap expansion, speed up the inflation, increase the expansion area, and reduce the contraction of the myocutaneous flap. It is a safe and convenient method with which to assist myocutaneous flap expansion.
尽管使用扩张的肌皮瓣有许多优点，但时间过程延长了。急性扩张期间的净表面积增加不足。在这项研究中，应用肉毒毒素 A 来缩短皮瓣扩张周期，同时获得满足手术要求的足够表面积。
作者的实验使用了 7 头小型猪。每头猪的背腰段两侧随机分为肉毒毒素 A 处理组和生理盐水处理组。在肌下袋中植入两个 200 毫升的扩张器。2 周后开始充气，以盲法观察扩张期。最后一次充气后 2 周测量扩张面积，提升并原位缝合 10 x 6 cm 的肌皮瓣，并观察肌皮瓣的收缩。
肉毒毒素 A 将扩张时间缩短了 17 天（p < 0.001）。肉毒毒素 A 处理组有效扩张面积的平均增量（p = 0.009）和平均募集面积（p = 0.001）明显高于生理盐水处理组。此外，在转位后每个时间点，肉毒毒素 A 处理组的轴向长度和宽度收缩均低于生理盐水处理组（p < 0.001）。
肉毒毒素 A 可以降低肌皮瓣扩张的阻力，加快充气，增加扩张面积，减少肌皮瓣的收缩。这是一种安全方便的辅助肌皮瓣扩张的方法。
