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Fu JB, Manne R, Ngo-Huang A, Tennison JM, Ng AH, Andersen C, Woodward WA, Bruera E. Onabotulinum toxin injections for shoulder and chest wall muscle pain in breast cancer survivors: retrospective study - preliminary report. BMJ Support Palliat Care 2024:spcare-2024-004987. [PMID: 38839248 DOI: 10.1136/spcare-2024-004987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The primary objective of this retrospective review is to describe patient-reported improvement in muscular pain after initial treatment with onabotulinum toxin. A secondary objective was to determine other physiatry (physical medicine & rehabilitation (PM&R)) interventions ordered. METHODS Preliminary retrospective review of physiatry interventions for 47 patients referred by breast radiation oncology to PM&R at a tertiary referral-based academic cancer centre clinic from 1 January 2018 to 31 December 2021 for muscular shoulder/chest wall pain. RESULTS Patients were most commonly diagnosed with muscle spasm 27/47 (58%), lymphedema 21/47 (45%), myalgia/myofascial pain 16/47 (34%), radiation fibrosis 14/47 (30%), fatigue/deconditioning 13/47 (28%), neurological impairment 11/47 (23%) and joint pathology 3/47 (6%). The top three physiatric interventions were home exercise programme education (17/47, 36%), botulinum toxin injection (17/47, 36%) and physical or occupational therapy referral (15/47, 32%). Patients who had muscle spasms documented were more likely to have botulinum toxin recommended by physiatry (24/24) compared with those with questionable spasms (4/7) and those without spasms(0/16) (p=0.0005). 17/28 (60.7%) received botulinum toxin injection, and a total of 35 injections were performed during the study period. 94% (16/17) of patients who received botulinum toxin injection voiced improvement in pain after injection. CONCLUSION Botulinum toxin injections may play a role in the treatment of muscle spasm-related pain in breast cancer survivors. Additional blinded controlled research on the effectiveness of botulinum toxin injection after breast cancer treatment with spastic muscular shoulder/chest wall pain is needed.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Radhika Manne
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jegy M Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy H Ng
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark Andersen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wang X, Zhao M, Wang Q, Wang J, Wang T. Dynamic alterations in M2 macrophage subtypes enhance flap expansion efficiency and tissue regeneration. Cell Biochem Biophys 2024; 82:859-871. [PMID: 38441826 DOI: 10.1007/s12013-024-01237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/14/2024] [Indexed: 08/25/2024]
Abstract
Dilatation of soft skin tissue is a common surgical procedure in plastic surgery. M2 macrophages play a critical role in reducing inflammation, promoting epithelial and vascular endothelial cell proliferation, enhancing collagen synthesis in fibroblasts, and orchestrating extracellular matrix remodelling by promoting angiogenesis, epithelialisation, and fibrosis. Macrophages improve flap survival by promoting microangiogenesis and collagen remodelling. However, the role of macrophages in flap expansion has not yet been investigated. Improving the expansion efficiency of dilatation flaps and promoting flap vascularisation are the pressing problems in the fields of plastic and reconstruction surgery. In the present study, we used a mouse model to assess the effects of macrophage activation on skin expansion, thickness, ultrastructure, intradermal angiogenesis, and collagen and cytokine levels. Our findings revealed dynamic changes in the macrophage content and subtypes within the expansion flaps. The enrichment of M2 macrophages significantly enhanced the efficiency of flap expansion, vascularisation, and collagen synthesis. Our findings underline the pivotal role of M2 macrophages in tissue regeneration at the molecular and biochemical levels. These findings provide a basis for improving flap expansion efficiency using M2 macrophages.
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Affiliation(s)
- Xiangyue Wang
- The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Mingyu Zhao
- The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Qianwen Wang
- The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Jiaqi Wang
- The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Tailing Wang
- The Department of Facial and Neck Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
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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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Lippi L, de Sire A, Turco A, Ferrillo M, Kesikburun S, Baricich A, Carda S, Invernizzi M. Botulinum Toxin for Pain Relief in Cancer Patients: A Systematic Review of Randomized Controlled Trials. Toxins (Basel) 2024; 16:153. [PMID: 38535819 PMCID: PMC10974124 DOI: 10.3390/toxins16030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 07/23/2024] Open
Abstract
Cancer pain is one of the most disabling symptoms complained by cancer patients, with a crucial impact on physical and psychological well-being. Botulinum neurotoxins (BoNTs) type A and B have emerged as potential interventions for chronic pain; however, their role in these patients is still debated. Thus, this systematic review of randomized controlled trials aimed at assessing the effects of BoNT treatment for cancer pain to guide physicians in an evidence-based approach integrating BoNT in cancer care. Out of 5824 records, 10 RCTs satisfied our eligibility criteria and were included in the present work for a total of 413 subjects with several cancer types (breast, head and neck, esophageal, and thoracic/gastric cancers). While some studies demonstrated significant pain reduction and improved quality of life post-BoNT-A injections, outcomes across different cancer types were inconclusive. Additionally, several effects were observed in functioning, dysphagia, salivary outcomes, esophageal strictures, gastric emptying, and expansions. This review emphasizes the need for further standardized research to conclusively establish the efficacy of BoNT in comprehensive cancer pain management.
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Affiliation(s)
- Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.T.); (A.B.); (M.I.)
- Department of Scientific Research, Campus LUdeS, Off-Campus Semmelweis University of Budapest, 1085 Budapest, Hungary
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Alessio Turco
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.T.); (A.B.); (M.I.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Serdar Kesikburun
- Ankara Gaziler Physical Therapy and Rehabilitation Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Gulhane Medical School, University of Health Sciences Turkey, 06800 Ankara, Turkey;
| | - Alessio Baricich
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.T.); (A.B.); (M.I.)
- Physical and Rehabilitation Medicine, “Ospedale Maggiore della Carità” University Hospital, 28100 Novara, Italy
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, 1004 Lausanne, Switzerland;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.T.); (A.B.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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5
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Awadeen A, Fareed M, Elameen AM. The Impact of Botulinum Toxin Injection on the Outcomes of Breast Surgeries: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2023; 47:1771-1784. [PMID: 37464214 PMCID: PMC10582146 DOI: 10.1007/s00266-023-03466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/11/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Breast surgeries aim to restore the natural appearance of the breasts with acceptable functional and cosmetic outcomes. However, these surgical procedures may be associated with considerable adverse events. The present systematic review and meta-analysis was designed to reveal the functional and aesthetic outcomes of botulinum toxins (BTX) injection in patients subjected to breast surgeries. METHODS A literature review was performed up to 21 September 2022. All clinical studies included patients older than 18 years old and treated with BTX injection for breast surgeries were included. RESULTS The present study included 12 articles, encompassing 496 patients. The average dosage of BTX injection ranged from 20 to 100 units. Injecting BTX significantly reduced the mean post-operative opioid analgesics usage (SMD -1.577; 95% -2.087, -1.067; P < 0.001) and the risk of severe animation deformity (RR 12.37; 95% 1.76, 86.66; P = 0.01). There was a statistically significant higher mean expansion volume per visit in the BTX injection group (SMD 1.166; 95% 0.313, 2.018; P = 0.007). There was no statistically significant impact of BTX injection on the risk of surgical site infection (RR 0.59; 95% 0.15, 2.34; P = 0.45) and seroma (RR 0.51; 95% 0.03, 10.15; P = 0.66). CONCLUSIONS The present study revealed the potential benefits of BTX injection in breast surgeries. This included reduced post-operative analgesics, as well as the risk of severe animation deformity. This was accomplished with increased expansion volume per visit and a similar risk of BTX injection-related complications. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Abdelrahman Awadeen
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (Boys), Al-Azhar University, Al Mokhaym Al Daem, Gameat Al Azhar, Nasr City, Cairo, Egypt.
| | - Mohamed Fareed
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (Boys), Al-Azhar University, Al Mokhaym Al Daem, Gameat Al Azhar, Nasr City, Cairo, Egypt
| | - Ali Mohamed Elameen
- Department of Plastic and Reconstructive Surgery, El-Sahel Teaching Hospital, Cairo, Egypt
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Fajardo Perez M, Espinoza Morales K, Rodriguez Sojo JF, Prada Castellnos Y, Galluccio F. A Novel Two-Step Ultrasound-Guided Technique for Anesthesia and Postsurgery Analgesia in Gluteal Augmentation Surgery. Cureus 2023; 15:e43546. [PMID: 37593073 PMCID: PMC10427781 DOI: 10.7759/cureus.43546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
In recent years, there has been an increase in demand for gluteal augmentation and reshaping surgeries with intramuscular implants which are becoming increasingly popular. Until now, this surgery was mainly performed under general anesthesia, but recently locoregional anesthesia techniques, such as tumescent local anesthesia, are being applied more and more. Today, the use of ultrasound for locoregional anesthesia and analgesia allows us to perform techniques that are increasingly precise and burdened with lower risks. In this report, we present a novel two-step ultrasound-guided technique combining a botox injection in the gluteus maximus four weeks before surgery and tumescent anesthesia with a cluneal nerve block. Furthermore, the combination of anesthetic and analgesic techniques can guarantee a better result both in terms of surgical execution of the intervention and in reducing pain and improving patient comfort in the postoperative period.
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Affiliation(s)
- Mario Fajardo Perez
- Pain Medicine, Morphological Madrid Research Center (MoMaRC), Madrid, ESP
- Anatomical Lab, Universidad Cientifica del Sur, Lima, PER
| | - Karla Espinoza Morales
- Anesthesiology, Hospital Centro de Atención Integral en Salud (CAIS) de Puriscal, San José, CRI
| | | | | | - Felice Galluccio
- Rheumatology & Rehabilitation, Fisiotech Lab Studio, Firenze, ITA
- Pain Medicine, Morphological Madrid Research Center (MoMaRC), Madrid, ESP
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Fasano G, Grimaldi L, Nisi G, Calomino N, Cuomo R. The Regenerative Effects of Botulinum Toxin A: New Perspectives. J INVEST SURG 2022; 35:1074-1075. [DOI: 10.1080/08941939.2021.2008553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Giorgio Fasano
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - Luca Grimaldi
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - Giuseppe Nisi
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - Natale Calomino
- General Surgery Unit, Department of General Surgery, S. Maria Alle Scotte Hospital, Siena, Italy
| | - Roberto Cuomo
- Plastic and Reconstructive Surgery Unit, Department of Medicine Surgery and Neuroscience, University of Siena, Italy
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Yi KH, Lee HJ, Seo KK, Kim HJ. Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction. Toxins (Basel) 2022; 14:toxins14020107. [PMID: 35202134 PMCID: PMC8878018 DOI: 10.3390/toxins14020107] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 01/27/2023] Open
Abstract
Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20–40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones.
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Affiliation(s)
- Kyu-Ho Yi
- COVID-19 Division, Wonju Public Health Center, Wonju 26417, Korea;
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Hyung-Jin Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | | | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul 03722, Korea
- Correspondence:
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Yi KH, Lee JH, Kim HM, Kim HJ. The botulinum neurotoxin for pain control after breast reconstruction: neural distribution of the pectoralis major muscle. Reg Anesth Pain Med 2022; 47:322-326. [PMID: 35039438 DOI: 10.1136/rapm-2021-102653] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 01/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The use of the botulinum neurotoxin injection is a growing area of research and clinical activity, with a focus on its role in facilitating postoperative pain management after reconstructive breast surgery. The study aimed to find out the standard injection points for botulinum neurotoxin injection by revealing the intramuscular nerve arborization of the pectoralis major. METHODS Sihler's technique was conducted on the pectoralis major muscles (16 cadaveric specimens). The intramuscular nerve arborization was documented relative to the inferior border of the clavicle bone and lateral border of the sternum. RESULTS After the staining, the pectoralis major was divided into fifths transversely from the inferior border of the clavicle and vertically into fifths from the lateral border of the sternum. Intramuscular nerve arborization of the pectoralis major muscle was the largest in the middle sections of the muscle belly. DISCUSSION The results indicate that botulinum neurotoxin should be applied to the pectoralis major in certain regions. The regions of major arborization are optimal as the most effective and most reliable points for injecting botulinum neurotoxin.
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Affiliation(s)
- Kyu-Ho Yi
- Division of COVID-19, Wonju Public Health Center, Wonju, Korea
| | - Ji-Hyun Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | | | - Hee-Jin Kim
- Yonsei University Medical Center, Seodaemun-gu, Korea
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Reyes-Long S, Alfaro-Rodríguez A, Cortes-Altamirano JL, Lara-Padilla E, Herrera-Maria E, Romero-Morelos P, Salcedo M, Bandala C. The Mechanisms of Action of Botulinum Toxin Type A in Nociceptive and Neuropathic Pathways in Cancer Pain. Curr Med Chem 2021; 28:2996-3009. [PMID: 32767912 DOI: 10.2174/0929867327666200806105024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) is widely employed for cosmetic purposes and in the treatment of certain diseases such as strabismus, hemifacial spasm and focal dystonia among others. BoNT-A effect mainly acts at the muscular level by inhibiting the release of acetylcholine at presynaptic levels consequently blocking the action potential in the neuromuscular junction. Despite the great progress in approval and pharmaceutical usage, improvement in displacing BoNT-A to other pathologies has remained very limited. Patients under diagnosis of several types of cancer experience pain in a myriad of ways; it can be experienced as hyperalgesia or allodynia, and the severity of the pain depends, to some degree, on the place where the tumor is located. Pain relief in patients diagnosed with cancer is not always optimal, and as the disease progresses, transition to more aggressive drugs, like opioids is sometimes unavoidable. In recent years BoNT-A employment in cancer has been explored, as well as an antinociceptive drug; experiments in neuropathic, inflammatory and acute pain have been carried out in animal models and humans. Although its mechanism has not been fully known, evidence has shown that BoNT-A inhibits the secretion of pain mediators (substance P, Glutamate, and calcitonin gene related protein) from the nerve endings and dorsal root ganglion, impacting directly on the nociceptive transmission through the anterolateral and trigeminothalamic systems. AIM The study aimed to collect available literature regarding molecular, physiological and neurobiological evidence of BoNT-A in cancer patients suffering from acute, neuropathic and inflammatory pain in order to identify possible mechanisms of action in which the BoNT-A could impact positively in pain treatment. CONCLUSION BoNT-A could be an important neo-adjuvant and coadjuvant in the treatment of several types of cancer, to diminish pro-tumor activity and secondary pain.
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Affiliation(s)
- Samuel Reyes-Long
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Ciudad de Mexico, Mexico
| | - Alfonso Alfaro-Rodríguez
- Division de Neurociencias, Instituto Nacional de Rehabilitacion, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Jose Luis Cortes-Altamirano
- Division de Neurociencias, Instituto Nacional de Rehabilitacion, Secretaria de Salud, Ciudad de Mexico, Mexico
| | - Eleazar Lara-Padilla
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Ciudad de Mexico, Mexico
| | | | | | - Mauricio Salcedo
- Laboratorio de Oncologia Genomica, Unidad de Investigacion Medica en Enfermedades Oncologicas, Hospital de Oncologia, CMN-SXXI, IMSS, Ciudad de Mexico, Mexico
| | - Cindy Bandala
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Ciudad de Mexico, Mexico
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11
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Yi KH, Lee HJ, Lee JH, Seo KK, Kim HJ. Application of Botulinum Neurotoxin Injections in TRAM Flap for Breast Reconstruction: Intramuscular Neural Arborization of the Rectus Abdominis Muscle. Toxins (Basel) 2021; 13:269. [PMID: 33918558 PMCID: PMC8070362 DOI: 10.3390/toxins13040269] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed to determine the ideal injection points for botulinum neurotoxin injection by exploring the arborization patterns of the intramuscular nerves of the rectus abdominis muscle. A modified Sihler's method was performed on 16 rectus abdominis muscle specimens. Arborization of the intramuscular nerves was determined based on the most prominent point of the xyphoid process to the pubic crest. All 16 rectus abdominis muscle specimens were divided into four muscle bellies by the tendinous portion. The arborized portions of the muscles were located on the 5-15%, 25-35%, 45-55%, and 70-80% sections of the 1st, 2nd, 3rd, and 4th muscle bellies, respectively. The tendinous portion was located at the 15-20%, 35-40%, 55-60%, and 90-100% sections. These results suggest that botulinum neurotoxin injections into the rectus abdominis muscles should be performed in specific sections.
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Affiliation(s)
- Kyu-Ho Yi
- Wonju City Public Health Center, Wonju-Si, Kangwondo 26417, Korea;
- Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK 21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-J.L.); (J.-H.L.)
| | - Hyung-Jin Lee
- Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK 21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-J.L.); (J.-H.L.)
| | - Ji-Hyun Lee
- Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK 21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-J.L.); (J.-H.L.)
| | | | - Hee-Jin Kim
- Department of Oral Biology, Division in Anatomy and Developmental Biology, Human Identification Research Institute, BK 21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (H.-J.L.); (J.-H.L.)
- Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul 03722, Korea
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12
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Botulinum Toxin A in Tissue Expander Breast Reconstruction: A Double-blinded Randomized Controlled Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3030. [PMID: 32983785 PMCID: PMC7489665 DOI: 10.1097/gox.0000000000003030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/11/2020] [Indexed: 11/25/2022]
Abstract
Subpectoral tissue expander breast reconstruction is often associated with muscle spasms, pain, and discomfort during tissue expansion. In this study, we hypothesized that an intraoperative injection of botulinum toxin A (BTX-A) in the pectoralis major muscle reduces the pain associated with tissue expansion and improves women's physical well-being. Methods Between May 2012 and May 2017, women undergoing immediate subpectoral tissue expander breast reconstruction were randomized to administer 100 units of BTX-A or a placebo injection. A numeric pain intensity scale and the physical well-being scale of the BREAST-Q: Reconstruction Module were used to test our hypothesis. Data on postoperative oral narcotic consumption were not collected. Results Of the 131 women included in the analysis, 48% were randomized to placebo and 52% to BTX-A. The preoperative median pain intensity score was 0 [interquartile range (IQR), 0-1], and the median preoperative BREAST-Q score was 91 (IQR, 81-100). The median slopes for the change in pain intensity scores from baseline throughout tissue expansion for those randomized to placebo and BTX-A were -0.01 (IQR, -0.02 to 0.00) and -0.01 (IQR, -0.02 to 0.00), respectively (P = 0.55). The median slopes for the change in BREAST-Q scores from baseline throughout tissue expansion for those randomized to placebo and BTX-A were 0.04 (IQR, -0.17 to 0.14) and 0.02 (IQR, -0.06 to 0.13), respectively (P = 0.89). Conclusion In this study, we found that an intraoperative intramuscular injection of 100 units of BTX-A in the pectoralis major muscle did not reduce postoperative pain and patient-reported physical well-being when compared with placebo.
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13
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Egeo G, Fofi L, Barbanti P. Botulinum Neurotoxin for the Treatment of Neuropathic Pain. Front Neurol 2020; 11:716. [PMID: 32849195 PMCID: PMC7431775 DOI: 10.3389/fneur.2020.00716] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/11/2020] [Indexed: 01/16/2023] Open
Abstract
Botulinum neurotoxin is widely used for the treatment of central and peripherical neurological conditions. Initially used to treat strabismus, over the years its use has been expanded also to spasticity and other neurological disorders. This review summarizes the evidence from the published literature regarding its effect on neuropathic pain. Almost all investigations were performed using onabotulinum toxin type A (BoNT/A). Most studies provided positive results, even though toxin formulation, dose, dilution, injection techniques, and sites are heterogeneous across studies. Future larger, high-quality, specifically designed clinical trials are warranted to confirm botulinum neurotoxin efficacy in neuropathic pain.
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Affiliation(s)
- Gabriella Egeo
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Luisa Fofi
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University, Rome, Italy
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14
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15
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A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome. Curr Pain Headache Rep 2020; 24:41. [PMID: 32529416 DOI: 10.1007/s11916-020-00876-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Postmastectomy pain syndrome (PMPS) remains poorly defined, although it is applied to chronic neuropathic pain following surgical procedures of the breast, including mastectomy and lumpectomy in breast-conserving surgery. It is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy. Though the onset of pain is most likely to occur after surgery, there may also be a new onset of symptoms following adjuvant therapy, including chemotherapy or radiation therapy. RECENT FINDINGS The underlying pathophysiology is likely multifactorial, although exact mechanisms have yet to be elucidated. In this regard, neuralgia of the intercostobrachial nerve is currently implicated as the most common cause of PMPS. Numerous pharmacological options are available in the treatment of PMPS, including gabapentinoids, tricyclic antidepressants, selective serotonin reuptake inhibitors, NMDA receptor antagonists, and nefopam (a non-opioid, non-steroidal benzoxazocine analgesic). Minimally invasive interventional treatment including injection therapy, regional anesthesia, botulinum toxin, and neuromodulation has been demonstrated to have some beneficial effect. A comprehensive update highlighting current perspectives on the treatment of postmastectomy pain syndrome is presented with emphasis on treatments currently available and newer therapeutics currently being evaluated to alleviate this complex and multifactorial condition.
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16
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Zhou Y, Li H, Liang X, Du H, Suo Y, Chen H, Liu W, Duan R, Huang X, Li Q. The CCN1 (CYR61) protein promotes skin growth by enhancing epithelial-mesenchymal transition during skin expansion. J Cell Mol Med 2019; 24:1460-1473. [PMID: 31828970 PMCID: PMC6991652 DOI: 10.1111/jcmm.14828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/19/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
The skin expansion technique is widely used to induce skin growth for large-scale skin deformity reconstruction. However, the capacity for skin expansion is limited and searching for ways to improve the expansion efficiency is a challenge. In this study, we aimed to explore the possible mechanism of skin expansion and to find a potential therapeutic target on promoting skin growth. We conducted weighted gene coexpression network analysis (WGCNA) of microarray data generated from rat skin expansion and found CCN1 (CYR61) to be the central hub gene related to epithelial-mesenchymal transition (EMT). CCN1 up-regulation was confirmed in human and rat expanded skin and also in mechanically stretched rat keratinocytes, together with acquired mesenchymal phenotype. After CCN1 stimulation on keratinocytes, cell proliferation was promoted and partial EMT was induced by activating β-catenin pathway. Treatment of CCN1 protein could significantly increase the flap thickness, improve the blood supply and restore the structure in a rat model of skin expansion, whereas inhibition of CCN1 through shRNA interference could dramatically reduce the efficiency of skin expansion. Our findings demonstrate that CCN1 plays a crucial role in skin expansion and that CCN1 may serve as a potential therapeutic target to promote skin growth and improve the efficiency of skin expansion.
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Affiliation(s)
- Yiwen Zhou
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haizhou Li
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Liang
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hengyu Du
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingjun Suo
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Chen
- Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou Higher Education Mega Center, Guangzhou, China
| | - Wenhui Liu
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Duan
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolu Huang
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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De Groef A, Devoogdt N, Van Kampen M, De Hertogh L, Vergote M, Geraerts I, Dams L, Van der Gucht E, Debeer P. The effectiveness of Botulinum Toxin A for treatment of upper limb impairments and dysfunctions in breast cancer survivors: A randomised controlled trial. Eur J Cancer Care (Engl) 2019; 29:e13175. [PMID: 31571329 DOI: 10.1111/ecc.13175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/30/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the effectiveness of a single Botulinum Toxin A (BTX-A) infiltration in the pectoralis major muscle, in addition to a standard physical therapy (PT) programme on upper limb impairments and dysfunctions after breast cancer treatment. METHODS Fifty breast cancer patients with persistent pain 3 months after finishing treatment participated in a double-blinded randomised controlled trial. The intervention group received a single BTX-A infiltration. The control group received a placebo (saline) infiltration. Within one week after the infiltration, all patients attended an individual PT programme (12 sessions) during the first 3 months. Outcome parameters were active shoulder range of motion, upper limb strength, scapular statics and shoulder function. Measures were taken before the intervention, at 1, 3 (i.e. after the intervention) and 6 months follow-up. RESULTS No differences between groups were found for all outcome parameters over the course of 6 months. However, overall beneficial effects of the PT for active forward flexion shoulder range of motion and shoulder function were found in both groups. CONCLUSION A single Botulinum Toxin A (BTX-A) infiltration in the pectoralis major muscle, in addition to a PT programme cannot be recommended to treat upper limb impairments and dysfunctions after breast cancer treatment.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
| | - Laura De Hertogh
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
| | - Margot Vergote
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Physical Medicine and Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
| | - Philippe Debeer
- Department of Development and Regeneration, Orthopaedics, University Hospitals Leuven, Leuven, Belgium.,Institute for Orthopaedic Research and Training, KU Leuven - University of Leuven, Leuven, Belgium
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18
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Elia R, Nacchiero E, Vestita M, Giudice G. "Reply to Letter to the Editor" The post-mastectomy pain syndrome-A systematic review of the treatment modalities. Breast J 2019; 25:566-567. [PMID: 30964214 DOI: 10.1111/tbj.13286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Rossella Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Eleonora Nacchiero
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Michelangelo Vestita
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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19
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Li T, Liu Y, Zhang W. Botulinum Toxin A Plays an Important Role in the Placement of Implants Deep Within the Pectoralis Major Muscle for Mammaplasty: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2018; 42:1519-1530. [PMID: 30083802 DOI: 10.1007/s00266-018-1203-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breast prosthesis implants have been safely and efficiently used in the plastic surgery department. With the increasing demand for aesthetics, these silicon implants were not only used in breast augmentation surgery but also in breast reconstruction after mastectomy. Nevertheless, breast prosthesis implantation brings a lot of complications, such as: postoperative chronic pain, capsule contracture, prosthesis displacement and prosthesis rupture and infection in severe cases. From the year 1998, botulinum toxin A (BTX-A), a neurotoxin, has been reported to be effective for pain control, capsule contracture lessening, expander enlargement and so on. However, those articles included all kinds of study types: randomized, double-blinded controlled trial (RCT), nonrandomized trial, retrospective analysis and case series, besides the outcomes were varied. To clarify how BTX-A acts at the mammaplasty field, we made this systematic review and meta-analysis. PURPOSE To review how BTX-A acts in the field of mammaplasty as well as discuss the relative mechanisms of BTX-A and the related research progress. METHODS We searched Pubmed, Embase, Cochrane, Web of science, Clinical trials, Wanfang Database and VIP from inception until March 2018 for papers reporting the use of BTX-A in the breast surgery using implants deep within the pectoralis major muscle. System review, viewpoints and case reports were excluded. RESULTS Ten articles met the criteria for inclusion including six prospective controlled (2 RCT; 4 other trails), three retrospective cohorts and one case series. These studies were all about patients using BTX-A during or after breast surgery with expanders or prostheses. A total of 682 patients were enrolled, 543 (79.61%) accepted BTX-A injection, 185 underwent mastectomies with immediate reconstruction, 13 with delayed reconstruction, 295 mastectomies with either immediate or delayed reconstruction and 189 with breast augmentation using silicone prostheses. The study time ranging from 4 months to 13 years, 15 patients (2.76%) received BTX-A injection more than two times, 9.2% received less than 75 U BTX-A, 34.3% 75-100 U, 0.18% 250 U, and in 56.4% the dosage was not stated. No complications associated with BTX-A were mentioned, almost all the studies reported efficacy for pain control. Other assessments included increased speed of expander enlargement and volume were mentioned in four papers, two articles analyzed the visual analogue scores, three suggested relief of capsular contracture, two reported lower narcotic use, three mentioned shorter hospital stays and one proved lowering the rate of unplanned expander. It seems all the studies demonstrate the valid usage of BTX-A, but the quality of this evidence still under the line. CONCLUSION We could try to use BTX-A as a new method in the field of mammaplasty. There are so many advantages such as postoperative pain relief, reducing the hospital stay, and increasing operation success rate, but rigorous methodological evidence is still lacking. A lot of studies were retrospective, only two studies used the RCT method. Therefore, to obtain strong evidence to clarify the usage of BTX-A, more randomized double-blinded controlled trials will be required, meanwhile the mechanism study adds to the evidence. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Tian Li
- Breast Surgery Department, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201900, China
| | - Yan Liu
- Jingjiang Hospital of Traditional Chinese Medicine, Jingjiang, China
| | - Weihong Zhang
- Breast Surgery Department, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201900, China.
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20
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Silberstein E, Maor E, Sukmanov O, Bogdanov Berezovsky A, Shoham Y, Krieger Y. Effect of Botulinum Toxin A on Muscle Healing and its Implications in Aesthetic and Reconstructive Surgery. Aesthet Surg J 2018; 38:557-561. [PMID: 29145580 DOI: 10.1093/asj/sjx207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Muscle activity contributes to the enhancement of facial aging deformity, blepharospasm, cerebral palsy spasticity, trismus, torticollis, and other conditions. Myotomy of the involved muscles in order to reduce the deformity has variable success rates due to muscle healing and regeneration of activity. OBJECTIVES The goal of this study was to investigate whether blocking striated muscle activity with Botulinum toxin (BtxA) during the healing time after myotomy alters the healing process and reduces long-term muscle activity. METHODS Eighteen Sprague Dawley rats where divided into 3 groups: group A (n = 7) underwent myotomy of their Latisimus Dorsi muscle; group B (n = 7) underwent myotomy and injection of BtxA into their severed muscle; group C (n = 4) injection of BtxA only. Muscle strength was tested periodically using a grip test. RESULTS Starting at week 16 and until the termination of study at week 22, group B (Myotomy + BtxA) showed significant reduction in muscle power compared to the two control groups. CONCLUSIONS Addition of BtxA injection into a muscle immediately after myotomy may interfere with muscle healing and contribute to a more successful long-term result.
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Affiliation(s)
- Eldad Silberstein
- Chief of the Head and Neck Reconstruction Unit, Department of Plastic and Reconstructive Surgery. Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ehud Maor
- Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery. Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oleg Sukmanov
- Attending Pathologist, Department of Pathology, Wolfson Medical Center, Holon, Israel
| | - Alexander Bogdanov Berezovsky
- Chief of the Department, Department of Plastic and Reconstructive Surgery. Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaron Shoham
- Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery. Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuval Krieger
- Chief of the Burn Unit, Department of Plastic and Reconstructive Surgery. Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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21
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Gabriel A, Maxwell GP. Commentary on: Effect of Botulinum Toxin A on Muscle Healing and its Implications in Aesthetic and Reconstructive Surgery. Aesthet Surg J 2018; 38:562-564. [PMID: 29340596 DOI: 10.1093/asj/sjx243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Allen Gabriel
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | - G Patrick Maxwell
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA
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22
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Progress on Botulinum Toxin Type A-Induced Pain Relief in the Field of Plastics. J Craniofac Surg 2017; 28:2045-2052. [DOI: 10.1097/scs.0000000000003981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Becker H, Fregosi N. The Impact of Animation Deformity on Quality of Life in Post-Mastectomy Reconstruction Patients. Aesthet Surg J 2017; 37:531-536. [PMID: 28158447 DOI: 10.1093/asj/sjw264] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Animation deformity after subpectoral breast implant placement has been documented; however, the actual prevalence and effect on patient quality of life has not been studied much. Objectives The purpose of this study was to show that all patients with subpectoral implants experience some degree of animation deformity and that it can affect their quality of life, including causing embarrassment and discomfort in reconstructed patients. Methods Patients who underwent breast implant surgery were contacted for inclusion in the study. Patients were obtained from a single surgeon's practice but included patients operated on outside the practice, and those seen in the practice for a consultation. A six-item questionnaire was developed by the senior author (H.B.) and the medical student (N.F.) involved in the study, to assess quality of life related to animation deformity. Patients had their degree of animation deformity assessed by the senior author and a medical student. Results Of 25 patients who agreed to the questionnaire and assessment, 20% had grade I distortion, 44% grade II, 24% grade III, and 12% grade IV. Of the patients questioned, 80% were bothered by an animation deformity and 45% of those patients were bothered to a significant degree (≥6 out of 10). In addition, 48% of patients felt that the animation deformity interfered with their daily life, and 28% (7/25) of patients underwent, or were scheduled to undergo, revision of their reconstruction at the time of interview. The degree of the clinically observed animation deformity was correlated with patient dissatisfaction, with an R value of 0.47 (P value = 0.0145). Conclusions All patients with subpectoral implant positioning will experience some degree of animation deformity. Especially in the reconstructed breast population, animation deformity, and its severity, affects patients' quality of life. Other approaches to reconstruction should be considered to prevent animation deformity in this population. Level of Evidence 4.
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Affiliation(s)
- Hilton Becker
- Dr Becker is a Voluntary Faculty Member, Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, FL; and an Affiliate Associate Professor, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL. Ms Fregosi is a medical student, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Nicole Fregosi
- Dr Becker is a Voluntary Faculty Member, Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, FL; and an Affiliate Associate Professor, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL. Ms Fregosi is a medical student, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
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