Motamed Sadrollah, Fattahy Dolatabadi Mohsen, Zehtabvar Omid, Sabet Diveshli Babak, Gharib Atoosa, Mollasharifi Tahmineh, Rouientan Abdol Reza
Department of Plastic Surgery, 15 Khordad Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Iran.
World J Plast Surg. 2025;14(1):17-27. doi: 10.61186/wjps.14.1.17.
Although many previous studies verified the role of BTX-A in the augmentation of flap survival and decreasing the rate of necrosis in random pattern cutaneous flaps, drug injection at different times has not been investigated in this regard. This study compares the effect of BTX- A injection time at 0, 3, and 7 days before surgery to determine the best and most effective injection time.
In 20 male rats, divided into four equal groups, on different days of pre-operation (0, 3, or 7 days) BTX-A or saline was administered to the whole length of the flap. Random pattern dorsal skin flaps with 4:1 length-to-width ratios were elevated and returned to the original position. Flap survival was evaluated on day 10 and 20 after surgery and a histopathological examination were performed 20 days after flap elevation.
The BTX-A group had a greater survival mean compared with the saline group (87.92±16.30 vs 65.60±30.71 or 1.34 fold increase in survival rate) in flaps with a length-to-width ratio of 4:1 ( = 0.05), and If botulinum toxin is injected 7 days before flap elevation, this increase in survival will be 1.5 times (97.5±4.06 vs 65.60±30.71) compared to the saline group ( = 0.02).
Preoperative injection of botulinum toxin type A in random pattern skin flaps increases skin flap survival in rats, and the best time for injections is 7 days before flap elevation. We found a reduction in the proliferation of cutaneous myofibroblasts in flaps by injecting BTX-A. It could play a role in increasing blood flow and survival by reducing wound contraction, however, more studies should be conducted to determine the possible mechanism.
尽管此前许多研究证实了A型肉毒毒素（BTX-A）在提高随意型皮瓣存活率及降低坏死率方面的作用，但尚未对不同时间注射该药物进行过这方面的研究。本研究比较了术前0天、3天和7天注射BTX-A的效果，以确定最佳且最有效的注射时间。
将20只雄性大鼠平均分为四组，在术前不同天数（0天、3天或7天）对皮瓣全长注射BTX-A或生理盐水。掀起长宽比为4:1的随意型背部皮瓣并复位。术后第10天和第20天评估皮瓣存活情况，并在皮瓣掀起20天后进行组织病理学检查。
在长宽比为4:1的皮瓣中，BTX-A组的平均存活率高于生理盐水组（87.92±16.30对65.60±30.71，存活率增加1.34倍）（P = 0.05），且如果在皮瓣掀起前7天注射肉毒毒素，与生理盐水组相比，存活率的增加将达到1.5倍（97.5±4.06对65.60±30.71）（P = 0.02）。
术前对随意型皮瓣注射A型肉毒毒素可提高大鼠皮瓣存活率，最佳注射时间为皮瓣掀起前7天。我们发现注射BTX-A可减少皮瓣中皮肤肌成纤维细胞的增殖。它可能通过减少伤口收缩在增加血流和提高存活率方面发挥作用，然而，还需要进行更多研究以确定可能的机制。
