Fu Ziyao, Huang Hanzi, Huang Jiuzuo
Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cosmet Dermatol. 2022 Jan;21(1):176-190. doi: 10.1111/jocd.14617. Epub 2021 Dec 2.
Botulinum toxin type A (BTXA) has shown underlying effects for wound healing improvement. New small clinical trials keep emerging every year and updated evidence-based information is warranted. This study aimed to evaluate the efficacy and safety of BTXA for preventing scarring.
Four databases were searched to recruit randomized clinical trials (RCTs) which compared the surgical wounds treated with BTXA vs. those treated with placebo or blank control. The outcomes were primarily quantified by measures including the Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), Stony Brook Scar Evaluation Scales (SBSES), modified SBSES (mSBSES), and scar width. Patients' satisfaction and adverse events were also reported.
In total, 16 RCTs involving 671 cases (510 patients) were included. The outcome showed significant superiority of BTXA in VSS (mean difference [MD] = -1.32, 95% confidence interval [CI]: -2.00 to -0.65, p = 0.0001), VAS (MD = 1.29, 95% CI: 1.05-1.52, p < 0.00001), SBSES or mSBSES (MD = -0.18, 95% CI: -0.27 to -0.10, p < 0.0001), scar width (MD = -0.18, 95% CI: -0.27 to -0.10, p < 0.0001), and patients' satisfaction (risk ratio [RR] = 1.25, 95% CI: 1.06-1.49, p = 0.01). No significant difference of adverse events incidence was observed (RR = 1.46 95% CI: 0.64-3.33, p = 0.36).
Botulinum toxin type A is effective and safe for postoperative scar prevention and wound healing improvement, especially for facial wounds of Asians. Further studies should manage to standardize the treatment algorithm, while mSBSES is recommended for scar assessment.
A型肉毒杆菌毒素（BTXA）已显示出对改善伤口愈合的潜在作用。每年都有新的小型临床试验不断涌现，因此需要更新基于证据的信息。本研究旨在评估BTXA预防瘢痕形成的有效性和安全性。
检索四个数据库，以招募随机临床试验（RCT），这些试验比较了接受BTXA治疗的手术伤口与接受安慰剂或空白对照治疗的手术伤口。主要通过包括温哥华瘢痕量表（VSS）、视觉模拟量表（VAS）、石溪瘢痕评估量表（SBSES）、改良SBSES（mSBSES）和瘢痕宽度在内的测量指标进行量化。还报告了患者的满意度和不良事件。
总共纳入了16项RCT，涉及671例患者（510名患者）。结果显示，BTXA在VSS（平均差[MD]= -1.32，95%置信区间[CI]：-2.00至-0.65，p = 0.0001）、VAS（MD = 1.29，95%CI：1.05 - 1.52，p < 0.00001）、SBSES或mSBSES（MD = -0.18，95%CI：-0.27至-0.10，p < 0.0001）、瘢痕宽度（MD = -0.18，95%CI：-0.27至-0.10，p < 0.0001）以及患者满意度（风险比[RR]= 1.25，95%CI：1.06 - 1.49，p = 0.01）方面具有显著优势。未观察到不良事件发生率的显著差异（RR = 1.46，95%CI：0.64 - 3.33，p = 0.36）。
A型肉毒杆菌毒素对预防术后瘢痕形成和改善伤口愈合有效且安全，尤其对于亚洲人的面部伤口。进一步的研究应设法规范治疗方案，同时建议使用mSBSES进行瘢痕评估。
