182: Chemical Myotomy With Botulinum Toxin for Abdominal Wall Reconstruction: A Porcine Pilot Study

Harth, KC; Rosem, MJ; Blatnik, Jeffrey A.; Schomisch, Steve J.; Cash, Alexander C; Soltanian, Hooman

doi:10.1097/01.prs.0000396869.71673.ad

Cited by 4 publications

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“…22 The “chemical component separation” provided by BTX has also been shown to achieve 79% of the tension of a mechanical components separation in pigs. 23 Whether this translates into a beneficial clinical effect in humans, however, is uncertain. In the only previously existing study of BTX in the OA, we were able to demonstrate a significant rate of improvement in primary fascial closure from 66% to 83% after BTX; however, while BTX injection into the abdominal wall in the OA setting was demonstrated, it was the inherent limitations from this flawed retrospective study which prompted us to perform the current clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin A–induced paralysis of the lateral abdominal wall after damage-control laparotomy

Zielinski

Kuntz

Zhang

et al. 2016

Journal of Trauma and Acute Care Surgery

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INTRODUCTION Damage control laparotomy (DCL) is a life-saving operation used in critically ill patients; however, interval primary fascial closure remains a challenge. We hypothesized that flaccid paralysis of the lateral abdominal wall musculature induced by Botulinum Toxin A (BTX), would improve of rates of primary fascial closure, decrease duration of hospital stay (LOS), and enhance pain control. METHODS Consenting adults who had undergone a DCL at two institutions were prospectively randomized to receive ultrasound-guided injections of their external oblique, internal oblique, and transversus abdominus muscles with either BTX (150cc, 2units/cc) or placebo (150cc 0.9%NaCl). Patients were excluded if they had a BMI>50, remained unstable or coagulopathic, were home O2 dependent or had an existing neuromuscular disorder. Outcomes were assessed in a double-blinded manner. Univariate and Kaplan Meier estimates of cumulative probability of abdominal closure were performed. RESULTS We randomized 46 patients (24 BTX, 22 placebo). There were no significant differences in demographics, comorbidities, and physiological status. Injections were performed on average 1.8 ± 2.8 days after DCL (range 0-14). The 10-day cumulative probability of primary fascial closure was similar between groups: 96% for BTX (95% CI 72%-99%) and 93% for placebo (95% CI 61%-99%); HR =1.0 (95% CI 0.5-1.8). No difference between BTX and placebo groups was observed for LOS (37 vs 26 days, p=0.30) or intensive care unit stay (17 vs 11 days, p=0.27). There was no difference in median morphine equivalents following DCL. The overall complication rate was similar (63% vs 68%, p=0.69), with 2 deaths in the placebo group and 0 in the BTX group. No BTX or injection procedure complications were observed. CONCLUSION Use of BTX after DCL was safe but did not appear to affect primary fascial closure, LOS, or pain modulation after DCL. Given higher than expected rates of primary fascial closure, type II error may have occurred.

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Section: Discussionmentioning

confidence: 99%