Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
J Plast Reconstr Aesthet Surg. 2013 Feb;66(2):209-14. doi: 10.1016/j.bjps.2012.09.012. Epub 2012 Oct 25.
The tension vectors acting on the wound edges are transmitted to immature collagen fibres synthesised during the normal healing phase. This accounts for scar widening as well as hypertrophic and hyperpigmented scars. The aim of our study was to evaluate whether early injections of botulinum toxin type A (BTA), which induces temporary muscular paralysis, decreases tension vectors on wound edges and enhances scarring of facial wounds.
Thirty patients with facial wounds were enrolled in this study and randomised into two groups with or without injection of BTA within 72 h postoperatively. BTA was injected into the facial muscles directly or indirectly involved in scar widening. Scars were assessed at a 1-year follow-up visit by patients using the Patient Scar Assessment Scale (PSAS) scale, by an independent evaluator using the Observer Scar Assessment Scale (OSAS) and the Vancouver Scar Scale (VSS), and by a board of six experienced medical specialists using the Visual Analogue Scale (VAS) with standardised photographs.
At the 1-year visit, 24 patients were reviewed and six patients were lost to follow-up. No statistically significant differences were found between the two groups for the PSAS, OSAS and VSS scores. However, the median VAS rated by the six evaluators was 8.25 for the botulinum toxin-treated group compared with 6.35 for the control group. This result was statistically different, demonstrating improved scarring with BTA.
Thanks to chemoimmobilisation, injections of BTA appear to improve cosmesis of facial wounds. Accordingly, they would be beneficial for use in young patients for wounds without tissue loss, lying perpendicular to the reduced tension lines of the skin of the face.
作用于伤口边缘的张力矢量被传递到正常愈合阶段合成的未成熟胶原纤维上。这导致了疤痕增宽以及增生性和色素沉着性疤痕。我们的研究目的是评估早期注射肉毒杆菌毒素 A（BTA）是否会减少伤口边缘的张力矢量，并增强面部伤口的疤痕形成，肉毒杆菌毒素 A可诱导暂时性肌肉瘫痪。
这项研究纳入了 30 名面部伤口患者，并随机分为两组，一组在术后 72 小时内注射 BTA，另一组不注射。BTA 直接或间接注射到参与疤痕增宽的面部肌肉中。在 1 年的随访中，患者使用患者疤痕评估量表（PSAS）、独立评估者使用观察者疤痕评估量表（OSAS）和温哥华疤痕量表（VSS）、由六名经验丰富的医学专家组成的委员会使用带有标准化照片的视觉模拟量表（VAS）对疤痕进行评估。
在 1 年的随访中，24 名患者接受了评估，6 名患者失访。两组患者的 PSAS、OSAS 和 VSS 评分均无统计学差异。然而，六位评估者评定的中位数 VAS 为肉毒杆菌毒素治疗组 8.25，对照组 6.35。这一结果具有统计学差异，表明 BTA 可改善疤痕外观。
由于化学固定作用，BTA 注射似乎改善了面部伤口的美容效果。因此，对于无组织缺失、垂直于面部皮肤减少张力线的年轻患者，BTA 注射可能会有益。
