Is there a role for botulinum toxin A in the emergency setting for delayed abdominal wall closure in the management of the open abdomen? A systematic review

Abstract

Introduction Emergency laparotomy for either trauma or non-trauma indications is common and management is varied. Use of the open abdomen technique allowing for planned re-look is an option; however, performing delayed definitive fascial closure (DFC) following this can be a challenge. The use of botulinum toxin-A (BTX) infiltration into the lateral abdominal wall has been well documented within the elective setting; its use within the emergency setting is undecided. This systematic review assesses the efficacy and safety of BTX injection into the lateral abdominal wall muscles in the emergency setting. The primary outcome is DFC rate. Methods Systematic review was performed according to the PROSPERO registered protocol (CRD42020205130). Papers were dual screened for eligibility, and included if they met pre-stated criteria where the primary outcome was DFC. Articles reporting fewer than five cases were excluded. Bias was assessed using the Cochrane Risk of Bias and Joanna Brigg’s appraisal tools. Findings Fourteen studies were screened for eligibility, twelve full texts were reviewed and two studies were included. Both studies showed evidence of bias due to confounding factors and lack of reporting. Both studies suggested significantly higher rates of DFC than reported in the literature against standard technique (90.7% vs 66%); however, these data are difficult to interpret due to strict study inclusion criteria or lack of a control population. Conclusion The use of BTX is deemed safe and its effects in the emergency situation may have great potential. Unfortunately, to date, there is insufficient evidence to facilitate opinion.

Vacuum assisted closure with mesh mediated fascial traction of open abdominal wounds and acute fascial dehiscence, a single institution experience

“…Luton et al conducted a systematic review in 2022 and determined that it is a safe option and could be considered for use in the emergency setting. 16 We have demonstrated a low complication rate. There were no deep or superficial wound infections or haematomas after skin closure.…”

“…Luton et al . conducted a systematic review in 2022 and determined that it is a safe option and could be considered for use in the emergency setting 16 …”

“…[13][14][15] BTA which is commonly used in elective procedures, has also been deemed safe and effective in the emergency setting, but it is much less widely utilized. 16 Previously described techniques do not involve any specific modification to preserve the fascial edges, nor any chemical component separation with BTA.…”

“…Botulinum toxin A (BTA) has been used in facilitating chemical components relaxation in abdominal wall reconstruction and management of the open abdomen; it is deemed safe, effective and shown to increase fascial closure rates 13–15 . BTA which is commonly used in elective procedures, has also been deemed safe and effective in the emergency setting, but it is much less widely utilized 16 . Previously described techniques do not involve any specific modification to preserve the fascial edges, nor any chemical component separation with BTA.…”