| BackgroundBotulinum toxin type A is a biologically toxic protein secreted by botulinum,which can block the release of peripheral acetylcholine by cleaving the SNAP-25 in the presynaptic membrane of cholinergic nerve endings,and cause muscle paralysis.It is often used clinically to treat eyelids,hemifacial spasm and certain strabismus,cervical dystonia,temporary improving moderate and severe facial wrinkles,etc.Its application in plastic surgery is minimally invasive,safe and efficient.It is widely used to treat wrinkles such as crow’s feet,eyebrow lines,and raised lines,as well as to improve masseter muscle hypertrophy and reshape facial contours.The healing of the surgical incision and scar are closely related to infection,operation,tension around the incision,and the activity of the surrounding muscle.Attempts have been made to reduce the formation of scars by subcutaneous injection of botulinum toxin type A around the incision.ObjectiveIn this study,the clinical efficacy of type A botulinum toxin to reduce scar hyperplasia after plastic surgery incision was evaluated by comparing the scar hyperplasia after using type A botulinum toxin with soft silicone dressing.MethodsTotal 45 patients after surgical excision at dermatology department in Qilu Hospital of Shandong University from November 2017 to June 2018 were randomly divided into botulinum toxin group(n=15),soft silicone dressing group(n=15)and control group(n=15).Botulinum to)xin group was given a subcutaneous injection of 10 iu botulinum toxin at the incision immediately after surgery.Soft silicone dressing group was given continuous external use of Soft silicone dressing(Mepiform)for at least 3 months.And the control group was treated regularly.The patients were followed up for 3 months and 6 months after surgery.The Vancouver scar scale(VSS)was used to evaluate the scar hyperplasia of the incision in the three groups.At 3 months and 6 mont:hs follow-up,the visual analog scale(VAS)was used to score the symptoms of scarring at the incision.The data were analyzed by SPSS 20.0 software according to statistics method.ResultsIn the course of the study,2 patients fell off in the Mepiform group,and 1 patient in the control group was lost to follow-up.Finally,42 patients completed the study.There were no significant differences in age,gender,and surgical site.1.Color:The changes of scar color scores in the botulinum toxin group,the Mepiform group and the control group were statistically significant at 3 months and 6 months after operation(P<0.05).3 months after operation,the scar color score of the botulinum toxin group was lower than that of the control group(P<0.05).There was no statistical evaluation of postoperative scar color score with the Mepiform group and the botulinum toxin group or the control group.Learning differences(P>0.05).6 months after operation,the postoperative scar color scores of the botulinum toxin group and the Mepiform group were lower than those of the control group,with statistically significant differences(P<0.01).There was no significant difference in postoperative scar color score between the botulinum toxin group and the Mepiform group(P>0.05).2.Thickness:The changes of scar thickness scores in the botulinum toxin group,the Mepiform group and the control group were statistically significant at 3 months and 6 months after operation(P<o.05).At 3 months after operation,there was no significant difference in postoperative scar thickness score in the botulinum toxin group,the Mepiform group and the control group(P>0.05).At 6 months after operation,the postoperative scar color scores of the botulinum toxin group and the Mepiform group were lower than those of the control group(P<0.05).There was no significant difference in postoperative scar color score between the botulinum toxin group and the Mepiform group(P>0.05).3.Blood Vessel:The changes of scar blood vessel distribution scores in the botulinum toxin group,the Mepiform group and the control group were statistically significant at 3 and 6 months after operation(P<0.05).At 3 months after operation,the distribution of scar blood vessels in the botulinum toxin group was lower than that in the control group(P<0.05).The distribution of postoperative scar blood vessels with the Mepiform group or the botulinum toxin group and the control group.There was no statistical difference(P>0.05).At 6 months after operation,the scores of scar blood vessel distribution in the botulinum toxin group and the Mepiform group were lower than those in the control group(P<0.01).There was no significant difference in postoperative scar vessel distribution between the botulinum toxin group and the Mepiform group(P>0.05).4.Softness:The changes of scar softness scores in the botulinum toxin group,the Mepiform group and the control group were statistically significant at 3 months and 6 months after operation(P<0.05).At 3 months after operation,the score of scar softness in the botulinum toxin group was lower than that in the control group(P<0.05).There was no significant difference in the postoperative softness score between the Mepiform group with the botulinum toxin group or the control group(P>0.05).At 6 months after operation,the scores of postoperative scar softness in the botulinum toxin group and the Mepiform group were lower than those in the control group(P<0.05).There was no significant difference in postoperative scar softness score between the botulinum toxin group and the Mepiform group(P>0.05).5.VSS:At 3 and 6 months after operation,the changes of total VSS scores in the botulinum toxin group,the Mepiform group and the control group were statistically significant(P<0.05).At 3 months after operation,the scores of scar softness in the botulinum toxin group and the Mepiform group were lower than those in the control group,which was statistically significant(P<0.05).There was no significant difference in the total score of postoperative scar VSS between the botulinum toxin group and the Mepiform group(P>0.05).At 6 months after operation,the total score of postoperative scar VSS in the botulinum toxin group and the Mepiform group was lower than that of the control group,which was statistically significant(P<0.01).There was no significant difference in the total score of postoperative scar VSS between the botulinum toxin group and the Mepiform group(P>0.05).6.Pruritus:The changes of crease and itching visual analog scales in the botulinum toxin group,the Mepiform group and the control group were statistically significant at 3 and 6 months after operation(P<0.05).At 3 months after operation,the visual analog scale score of creases in the botulinum toxin group was lower than that of the control group(P<0.05).There was no significant difference in postoperative scar itch visual analog scale score between the Mepiform group and the botulinum toxin group and the control group(P>0.05).At 6 months after operation,the visual analog scale score of creases in the botulinum toxin group was lower than that of the control group(P<0.05).There was no significant difference in postoperative scar itch visual analog scale score between the Mepiform group and the botulinum toxin group or the control group(P>0.05).7.Ache:There was no significant difference in the visual analog scale of creases between the botulinum toxin group at 3 months and 6 months after operation(P>0.05),There were statistically significant changes in the results of visual analog scales of creases in the Mepiform group and the control group at 3 months and 6 months after operation(P<0.05).At 3 months after operation,the visual analog scale score of creases in the botulinum toxin group was lower than that of the control group(P<0.05).There was no significant difference in postoperative scar itch visual analog scale score between the Mepiform group and the botulinum toxin group and the control group(P>0.05).At 6 months after operation,there was no significant difference in the visual analog scale of scar pruritus between the botulinum to,xin group,the Mepiform group and the control group(P>0.05).Conclusion1.Botox and soft silicone dressings can effectively reduce the formation of scars at the incision.2.There was no significant difference in long-term observation of the clinical efficacy between botulinum toxin and soft silicone dressings in reducing scar formation.3.Compared with soft silicone dressing,botulinum toxin treatment has the advantages of less side effects and high patient compliance. |
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