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Lin G, Zhang X, Song Z, Xu Y, Wang H, Zheng R, Fan F, You J. Clinical Application of Botulinum Toxin A on Nasal Reconstruction with Expanded Forehead Flap for Asian Patients. Aesthetic Plast Surg 2024:10.1007/s00266-024-04033-x. [PMID: 38653821 DOI: 10.1007/s00266-024-04033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Because of its unique advantages, frontal expansion has become a common tool for Asian nasal reconstruction, but it has the limitations of prolonging the duration and pain in the expansion area. Based on the fact that the denervation effect of botulinum toxin type A (BTX-A) has been widely used in the reconstruction of superficial organs, we hypothesized that BTX-A would shorten the length of nasal reconstruction sequence and alleviate the discomfort of patients. METHODS A comparative retrospective study was conducted of consecutive patients underwent sequential treatment of nasal reconstruction between June 2010 and July 2012. Data on demographics, BTX-A injection plan and expansion duration were collected and analyzed. Phased pain intensity outcomes were evaluated by visual analogue scale (VAS). Photographs were collected during the follow-up period. RESULTS Thirty patients were enrolled in the study; 15 (50%) with and 15 (50%) without BTX-A pre-injection. Demographic data were homogeneous. The duration of the observation group (BTX-A pretreated) (133.87 ± 13.64 days) was significantly shortened versus the control group (164.27 ± 14.08 days, P<0.001). At the initial stage, no significant difference was found in the VAS scores (P=0.64). At the medium stage, the VAS score of the observation group (2.07 ± 0.80) was significantly lower than the control group (3.00 ± 0.53, P<0.01). At the terminal stage, the VAS score of the observation group (1.93 ± 0.59) was significantly lower than the control group (2.73 ± 0.70) but with a narrower disparity. CONCLUSION Pre-injection of BTX-A is effective in shortening the duration of the expansion phase, as well as relieving the pain associated with expansion. LEVEL OF EVIDENCE IV The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .
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Affiliation(s)
- Guangxian Lin
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Xulong Zhang
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Zhen Song
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Yihao Xu
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Huan Wang
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Ruobing Zheng
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Fei Fan
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
| | - Jianjun You
- Center of Rhinoplasty, Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital and Institute, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Balik O. Quantitative Assessment of the Effects of Botulinum Toxin on Skin Perfusion by Laser Doppler Flowmetry: A Clinical Trial. J Craniofac Surg 2024; 35:e11-e14. [PMID: 37610009 DOI: 10.1097/scs.0000000000009639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 08/24/2023] Open
Abstract
Several studies reported an increase in skin glow, pore shrinkage, and an improvement in oily skin with its mesobotox-like use. The authors aimed to determine the extent of late changes in skin perfusion in the superficial dermis when Botulinium toxin A (Btx-A) is injected into the skin with mesotherapy, independent of any stimulant and surgery, using a laser Doppler flowmeter for analysis. Btx-A was applied to the right cheek and saline mesotherapy to the left cheeks of a total of 9 subjects. Two weeks later, their contribution to skin circulation was measured by the laser Doppler flowmeter. Although it was more on the side where Btx-A was applied, an increase in vascularity was observed on both sides of the subjects and no statistical difference could be found between the right and left cheeks in the late period.
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Mechanical Stretch Induced Skin Regeneration: Molecular and Cellular Mechanism in Skin Soft Tissue Expansion. Int J Mol Sci 2022; 23:ijms23179622. [PMID: 36077018 PMCID: PMC9455829 DOI: 10.3390/ijms23179622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Skin soft tissue expansion is one of the most basic and commonly used techniques in plastic surgery to obtain excess skin for a variety of medical uses. However, skin soft tissue expansion is faced with many problems, such as long treatment process, poor skin quality, high retraction rate, and complications. Therefore, a deeper understanding of the mechanisms of skin soft tissue expansion is needed. The key to skin soft tissue expansion lies in the mechanical stretch applied to the skin by an inflatable expander. Mechanical stimulation activates multiple signaling pathways through cellular adhesion molecules and regulates gene expression profiles in cells. Meanwhile, various types of cells contribute to skin expansion, including keratinocytes, dermal fibroblasts, and mesenchymal stem cells, which are also regulated by mechanical stretch. This article reviews the molecular and cellular mechanisms of skin regeneration induced by mechanical stretch during skin soft tissue expansion.
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Botulinum Toxin Type A for the Treatment of Skin Ulcers: A Review Article. Toxins (Basel) 2022; 14:toxins14060406. [PMID: 35737067 PMCID: PMC9230442 DOI: 10.3390/toxins14060406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
The normal biological wound healing process consists of three precisely and highly programmed phases that require optimal conditions including internal and external factors. Any negative factors that disrupt the sequence or time frame of the healing mechanism can result in a non-healing wound or chronic ulcers. Botulinum neurotoxin A (BoNT-A) which is generally known as anti-contraction of muscles has been reported as a successful treatment in various types of chronic ulcers. The aim of this study is to review the outcome of treatment with BoNT-A for chronic skin ulcers. The results demonstrated some positive effects of BoNT-A on chronic ulcers. Ischemic ulcers secondary to Raynaud’s phenomenon seem to be the most promising type of ulcers that have benefited from BoNT-A. The rationale behind using BoNT-A to fasten the wound healing process is also discussed. Further clinical trial studies should be conducted to affirm the efficacy of wound healing using BoNT-A administration.
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Adler M, Pellett S, Sharma SK, Lebeda FJ, Dembek ZF, Mahan MA. Preclinical Evidence for the Role of Botulinum Neurotoxin A (BoNT/A) in the Treatment of Peripheral Nerve Injury. Microorganisms 2022; 10:microorganisms10050886. [PMID: 35630331 PMCID: PMC9148055 DOI: 10.3390/microorganisms10050886] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/29/2022] [Accepted: 04/17/2022] [Indexed: 01/27/2023] Open
Abstract
Traumatic peripheral nerve injuries tend to be more common in younger, working age populations and can lead to long-lasting disability. Peripheral nerves have an impressive capacity to regenerate; however, successful recovery after injury depends on a number of factors including the mechanism and severity of the trauma, the distance from injury to the reinnervation target, connective tissue sheath integrity, and delay between injury and treatment. Even though modern surgical procedures have greatly improved the success rate, many peripheral nerve injuries still culminate in persistent neuropathic pain and incomplete functional recovery. Recent studies in animals suggest that botulinum neurotoxin A (BoNT/A) can accelerate nerve regeneration and improve functional recovery after injury to peripheral nerves. Possible mechanisms of BoNT/A action include activation or proliferation of support cells (Schwann cells, mast cells, and macrophages), increased angiogenesis, and improvement of blood flow to regenerating nerves.
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Affiliation(s)
- Michael Adler
- Neuroscience Department, Medical Toxicology Division, U.S. Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Rd., Aberdeen Proving Ground, MD 21010, USA
- Correspondence: ; Tel.: +1-410-436-1913
| | - Sabine Pellett
- Department of Bacteriology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI 53706, USA;
| | - Shashi K. Sharma
- Division of Microbiology, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD 20740, USA;
| | - Frank J. Lebeda
- Biotechnology, Protein Bioinformatics, Zanvyl Krieger School of Arts & Sciences, Johns Hopkins University, Advanced Academic Programs, 9601 Medical Center Drive, Rockville, MD 20850, USA;
| | - Zygmunt F. Dembek
- Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences, 3154 Jones Bridge Rd., Bethesda, MD 20814, USA;
| | - Mark A. Mahan
- Department of Neurosurgery, Clinical Neurosciences, University of Utah, 175 N Medical Drive East, Salt Lake City, UT 84132, USA;
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