Adel M Wilson1. 1. Department of Plastic Surgery, Cairo University, Cairo, Egypt. dr_adel_wilson@yahoo.com
Abstract
BACKGROUND: Wounds of the face, especially those lying perpendicular to the lines of Langer, are known to heal poorly with conspicuous scarring. Different methods have been tried to tackle this problem, including corticosteroid injections, irradiation, ultrasound, silicone applications, and many others. However, as expected, their effects were far from satisfactory, because they do nothing to alleviate the underlying pathologic process, which is the distracting effect of muscle pull on immature collagen. METHODS: In 40 patients with ugly scars of the face, botulinum toxin was used to induce temporary paralysis of the muscles during revision surgery, thus minimizing tension on healing wound edges until the collagen could mature. RESULTS: Using both objective and subjective assessment scales, 90 percent of patients ended up with an improved outcome. This new technique has been proven effective in primates and in this study was shown to be as effective in humans, yielding results superior to those of any other treatment modality. CONCLUSION: In view of the results of this study, it is considered worthwhile to offer patients with ugly scars of the face botulinum toxin injections simultaneous with revision surgery.
BACKGROUND: Wounds of the face, especially those lying perpendicular to the lines of Langer, are known to heal poorly with conspicuous scarring. Different methods have been tried to tackle this problem, including corticosteroid injections, irradiation, ultrasound, silicone applications, and many others. However, as expected, their effects were far from satisfactory, because they do nothing to alleviate the underlying pathologic process, which is the distracting effect of muscle pull on immature collagen. METHODS: In 40 patients with ugly scars of the face, botulinum toxin was used to induce temporary paralysis of the muscles during revision surgery, thus minimizing tension on healing wound edges until the collagen could mature. RESULTS: Using both objective and subjective assessment scales, 90 percent of patients ended up with an improved outcome. This new technique has been proven effective in primates and in this study was shown to be as effective in humans, yielding results superior to those of any other treatment modality. CONCLUSION: In view of the results of this study, it is considered worthwhile to offer patients with ugly scars of the face botulinum toxin injections simultaneous with revision surgery.
Authors: Leandra A Barnes; Clement D Marshall; Tripp Leavitt; Michael S Hu; Alessandra L Moore; Jennifer G Gonzalez; Michael T Longaker; Geoffrey C Gurtner Journal: Adv Wound Care (New Rochelle) Date: 2018-02-01 Impact factor: 4.730