Study On Botulinum Toxin Type A For The Prevention And Treatment Of Pathological Scars And Clinical Application

Objective:The incidence of pathological scar is high.There is no cure method at both home and abroad,It is a problem of the clinical treatment for plastic surgeons.In recent years,some scholars have proposed injection of botulinum toxin type A(BTXA)to prevent and treat pathological scar,and carried out the relevant basic experimental and clinical research.However,its clinical efficacy has not been confirmed.We will quantitatively analyze the satisfaction rate of BTXA injection in the treatment of keloid and the effects of BTXA on the proliferation of fibroblasts.We would like to verify both the prevention and treatment of BTXA on the efficacy of pathological scar.All the results will be used to provide a basis for clinical decision-making.Methods:It has been investigated for botulinum toxin type A(BTXA)to prevent or treat pathological scars in several experimental and clinical studies.We searched multiple database with certain search terms and collect of literature on the role of BTXA in the treatment of keloids and BTXA on the proliferation of fibroblasts.We made the heterogeneity test of the data and selected the fixed effect model or random effect model to calculate the effect of the combined value.Meta analysis was performed using stataSE 12 software.We conducted a two-way cohort study.According to the inclusion criteria,the exclusion criteria and diagnostic criteria,we chose 31 patients and 46 cases of scar screening from all cases from 2013 to 2016 in our department after pathological scar resection surgery with prophylactic injection of BTXA.Patients were followed up for at least 6 months.VSS score and VAS score were performed before the surgery and in the follow-up.The treatment points of prophylactic injection were described,and the results were analyzed statistically to evaluate the effect of BTXA injection.According to the inclusion criteria,the exclusion criteria and diagnostic criteria,we chose 17 patients and 23 cases of scar in BTXA group and 13 patients and 20 cases of scar in compound betamethasone group who all underwent intravenous injection.Patients in the BTXA group were injected every approximately 6 months while the patients in compound betamethasone group were given an interval of approximately 4 weeks.The patients were followed up for at least one year.Patient satisfaction rate were recorded and the related complications were recorded.To analyze the characteristics,advantages and disadvantages of each injection therapy,and provide guidance for the clinical treatment of pathological scar.Results:There were eight studies included in BTXA injection for keloid injection,the rate of satisfaction was 84.9%(95%CI:79.8%?90.4%).There were seven studies on the effect of BTXA on the proliferation of fibroblasts,the number of fibroblasts in the experimental group accounted for 55.8%(95%CI:35.0%?88.8%)of the control group.Immediate postoperative injection of BTXA to prevent pathological scar patients were well healed,not found long-term follow-up complications.Preoperative VSS score of the average:11.09±1.90 points,consistent with the normal distribution.The mean score of postoperative VSS score was 4.93±2.31 points.We use SPSS 17.0 software for paired t test,measured t value of 15.990 with statistically significant.In the patient's painful subjective evaluation follow-up,the improvement rate was 100%with good satisfaction.In the long-term follow-up,the total satisfaction of BTXA group was slightly higher than that of the compound betamethasone group.Among them,BTXA group was better than that of compound betamethasone group in terms of color and dysuria,and the satisfaction rate was higher in the aspects of uplift and volume change,and the satisfaction rate was slightly inferior to that of compound betamethasone group.The overall follow-up complication rate was much lower in the compound betamethasone group and had mild complications.Conclusion:Injection of BTXA can effectively prevent the occurrence of pathological scar,with good long-term follow-up effect.Injection of BTXA in the treatment of pathological scar satisfaction is better with low complications.It is a good and promising choice for the prevention and treatment of pathological scar.