Department of Plastic Surgery, The Fourth Affiliated Hospital, Anhui Medical University, 100 HuaiHai Road, Hefei, 230012, Anhui Province, China.
Department of Plastic Surgery, The First Affiliated Hospital, Anhui Medical University, 218 JiXi Road, Hefei, 230022, Anhui Province, China.
Aesthetic Plast Surg. 2019 Oct;43(5):1241-1249. doi: 10.1007/s00266-019-01358-w. Epub 2019 Mar 21.
The role of active scar prevention in postoperative scar management is important. Botulinum toxin type A (BTXA) has been shown to improve postoperative scars in the past decades. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of BTXA injection for scar prevention.
The authors searched the databases of Medicine, Embase, the Cochrane Library, Web of Science, and CINAHL from inception through November 2018 for randomized controlled trials (RCTs) reporting the use of BTXA in scar prevention. The outcomes were the visual analogue scale (VAS) score, Vancouver Scar Scale score, scar width, patient satisfaction and adverse events.
A total of nine RCTs were identified in this systematic review and meta-analysis. The VAS score was significantly higher in the BTXA group than in the control group (weighted mean difference (WMD) = 1.32, 95% confidence interval (CI) = 1.06-1.58, P < 0.00001). The Vancouver Scar Scale score was significantly lower in the BTXA group (WMD = - 1.25, 95% CI = - 2.23 to - 0.26, P = 0.01). The scar width was also significantly smaller in the BTXA group (WMD = - 0.18, 95% CI = - 0.24 to - 0.12, P < 0.00001). There was a significant difference in terms of patient satisfaction between the BTXA group and the control group (relative risk (RR) = 1.38, 95% CI = 1.09-1.74, P = 0.007). Only two studies reported complications, and other studies reported no complications during the follow-up period.
This systematic review and meta-analysis demonstrates that BTXA injection can reduce scar width in wounds and improve the overall appearance of postoperative scars and suggests that BTXA may be a safety therapy for scar prevention.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
积极预防术后瘢痕在术后瘢痕管理中具有重要作用。在过去几十年中，已证明肉毒杆菌毒素 A 型（BTXA）可改善术后瘢痕。本系统评价和荟萃分析的目的是评估 BTXA 注射预防瘢痕的有效性和安全性。
作者检索了从建库至 2018 年 11 月的 MEDLINE、Embase、Cochrane 图书馆、Web of Science 和 CINAHL 数据库，以获取报告 BTXA 用于预防瘢痕的随机对照试验（RCT）。结果是视觉模拟评分（VAS）、温哥华瘢痕量表评分、瘢痕宽度、患者满意度和不良反应。
本系统评价和荟萃分析共纳入 9 项 RCT。BTXA 组的 VAS 评分明显高于对照组（加权均数差（WMD）=1.32，95%置信区间（CI）=1.06-1.58，P<0.00001）。BTXA 组温哥华瘢痕量表评分明显较低（WMD=-1.25，95%CI=-2.23 至-0.26，P=0.01）。BTXA 组的瘢痕宽度也明显较小（WMD=-0.18，95%CI=-0.24 至-0.12，P<0.00001）。BTXA 组与对照组患者满意度存在显著差异（相对风险（RR）=1.38，95%CI=1.09-1.74，P=0.007）。只有两项研究报告了并发症，其他研究在随访期间未报告并发症。
本系统评价和荟萃分析表明，BTXA 注射可减少伤口的瘢痕宽度，改善术后瘢痕的整体外观，并提示 BTXA 可能是预防瘢痕的安全治疗方法。
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