From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Plast Reconstr Surg. 2021 Jun 1;147(6):1331-1341. doi: 10.1097/PRS.0000000000007986.
Although the effects of botulinum toxin A on hernia reconstruction have been consistently reported, few studies provide objective evidence. The authors aimed to compare the effects of chemical component separation with those of mechanical component separation, and with a combination of chemical and mechanical component separation, in a rat hernia model.
Rats were divided into four groups: 1, control; 2, chemical component separation; 3, mechanical component separation; and 4, chemical and mechanical component separation. Four weeks after hernia induction, botulinum toxin A was injected into groups 2 and 4. Hernia repair was performed 2 weeks after chemical component separation when mechanical component separation was performed in groups 3 and 4. Pretreatment and posttreatment defect sizes, traction forces, intraabdominal pressure, and hernia recurrences were analyzed.
The defect size was significantly decreased in groups 2 and 4 after chemical component separation. The traction force was significantly smaller in groups 2 and 3 compared with the control group, and the effects of chemical and mechanical component separation were additive. The mean intraabdominal pressure was 16.83 mmHg in group 1, 10.67 mmHg in group 2, 10.17 mmHg in group 3, and 9.67 mmHg in group 4, thus showing significant reductions following chemical and mechanical component separation. Recurrence was observed in all six animals (100 percent) in groups 1 and 3, but in only one of six (17 percent) in groups 2 and 4.
Preoperative botulinum toxin A significantly reduces hernia size (by 30 percent) and the traction force required to medialize the rectus abdominis. After hernia repair, chemical component separation decreases the intraabdominal pressure to a similar degree as mechanical component separation, but only chemical component separation appears to reduce hernia recurrence.
尽管已有研究一致报道肉毒毒素 A 对疝重建的影响，但鲜有研究提供客观证据。作者旨在比较化学性腹横筋膜分离与机械性腹横筋膜分离，以及化学性与机械性腹横筋膜分离联合应用对大鼠疝模型的影响。
将大鼠分为 4 组：1.对照组；2.化学性腹横筋膜分离组；3.机械性腹横筋膜分离组；4.化学性与机械性腹横筋膜分离联合应用组。疝诱导 4 周后，向组 2 和组 4 注射肉毒毒素 A。当组 3 和组 4 行机械性腹横筋膜分离时，在化学性腹横筋膜分离后 2 周行疝修补术。分析术前和术后的缺损大小、牵拉力、腹腔内压力和疝复发情况。
化学性腹横筋膜分离后组 2 和组 4 的缺损大小显著减小。与对照组相比，组 2 和组 3 的牵拉力显著减小，而化学性与机械性腹横筋膜分离联合应用的效果具有累加性。组 1 的平均腹腔内压力为 16.83mmHg，组 2 为 10.67mmHg，组 3 为 10.17mmHg，组 4 为 9.67mmHg，因此，化学性与机械性腹横筋膜分离后腹腔内压力均显著降低。组 1 和组 3 的 6 只动物（100%）均出现复发，而组 2 和组 4 中仅有 1 只（17%）出现复发。
术前应用肉毒毒素 A 可显著减小疝的大小（减小 30%）和使腹直肌内移所需的牵拉力。疝修补术后，化学性腹横筋膜分离可使腹腔内压力降低至与机械性腹横筋膜分离相似的程度，但只有化学性腹横筋膜分离似乎可降低疝复发率。
