From the Division of Otolaryngology-Head and Neck Surgery, Dalhousie University; the Division of Otolaryngology-Head and Neck Surgery, Queens University; and Stv. Leitender Oberarzt, Plastische Gesichtschirurgie, Universitäts-HNO-Klinik Regensburg.
Plast Reconstr Surg. 2019 Feb;143(2):375e-381e. doi: 10.1097/PRS.0000000000005264.
Recent research has indicated that botulinum toxin type A may have an inhibitory effect on the formation of fibroblasts and thus possibly decreases the severity of scar formation. Therefore, a trial was designed to assess the effects of botulinum toxin type A on scar formation after thyroid surgery.
A double-blind, randomized, controlled trial was designed. All patients underwent a preoperative survey to assess scar history. All patients underwent a total thyroidectomy, hemithyroidectomy, or parathyroidectomy through a standardized incision. At the conclusion of the case, one half of the incision was injected with botulinum toxin type A, and the other half was injected with saline (placebo). The scars were then evaluated at 4 weeks, 6 months, and 1 year postoperatively using subjective scar analysis scales.
A total of 40 patients were enrolled. There was no significant difference in scarring at any of the time points between the botulinum toxin type A-treated and placebo sides of the incision. A subgroup analysis was performed that examined the effects of botulinum toxin type A on those with a severe scar history. This demonstrated a significant decrease in scarring at 6 months postoperatively on the botulinum toxin type A-treated side.
This study indicates that botulinum toxin type A administration immediately after surgical closure of a thyroid incision does not demonstrate a difference in scar outcomes compared with the control side. However, there was less scarring in subjects who had a severe scar history. This study found opposite results to a similarly designed study. Further study is required to determine the optimal use of botulinum toxin type A for wound healing.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
最近的研究表明，A型肉毒毒素可能对成纤维细胞的形成具有抑制作用，从而可能降低疤痕形成的严重程度。因此，设计了一项试验来评估 A 型肉毒毒素对甲状腺手术后疤痕形成的影响。
设计了一项双盲、随机、对照试验。所有患者均进行术前调查以评估疤痕史。所有患者均通过标准化切口行全甲状腺切除术、甲状腺叶切除术或甲状旁腺切除术。在手术结束时，切口的一半注射 A 型肉毒毒素，另一半注射生理盐水（安慰剂）。然后在术后 4 周、6 个月和 1 年使用主观疤痕分析量表评估疤痕。
共纳入 40 例患者。在任何时间点，A 型肉毒毒素治疗侧和安慰剂侧的疤痕均无显著差异。对有严重疤痕史的患者进行亚组分析，结果表明术后 6 个月 A 型肉毒毒素治疗侧的疤痕显著减少。
本研究表明，甲状腺切口缝合后立即给予 A 型肉毒毒素与对照侧相比，在疤痕结局方面没有差异。然而，有严重疤痕史的患者的疤痕较少。本研究与设计相似的研究结果相反。需要进一步研究以确定 A 型肉毒毒素在伤口愈合中的最佳用途。
临床问题/证据水平：治疗，II 级。
