Kinetic and Reaction Pathway Analysis in the Application of Botulinum Toxin A for Wound Healing

Abstract

A relatively new approach in the treatment of specific wounds in animal models and in patients with type A botulinum toxin is the focus of this paper. The indications or conditions include traumatic wounds (experimental and clinical), surgical (incision) wounds, and wounds such as fissures and ulcers that are signs/symptoms of disease or other processes. An objective was to conduct systematic literature searches and take note of the reactions involved in the healing process and identify corresponding pharmacokinetic data. From several case reports, we developed a qualitative model of how botulinum toxin disrupts the vicious cycle of muscle spasm, pain, inflammation, decreased blood flow, and ischemia. We transformed this model into a minimal kinetic scheme for healing chronic wounds. The model helped us to estimate the rate of decline of this toxin's therapeutic effect by calculating the rate of recurrence of clinical symptoms after a wound-healing treatment with this neurotoxin.

The Expanding Therapeutic Utility of Botulinum Neurotoxins

“…The healing of a wound comprises four overlapping phases: haemostasis, inflammation, tissue proliferation, and remodeling (for review see [ 92 ]). Increased metabolic activity and inflammation during healing can induce muscle contractions around the edges of the wound, which in turn, creates repetitive tension on the wound [ 93 ]. This has the potential to not only delay the healing of the wound, but also to increase fibrosis and induce or aggravate hypertrophic scarring.…”

The use of botulinum toxin A to promote wound healing in a recurrent lip fissure

“…The area could in fact be considered a sphincter. The use of botulinum toxin A in the management of healing associated with a sphincter has been successful elsewhere in the body.…”

Botulinum toxin type A: implications in wound healing, facial cutaneous scarring, and cleft lip repair

“…19 , 20 Utilizing the temporary paralytic effect of botulinum toxin represents an interesting modality to reduce the cycles of micro-trauma in the early phases of wound healing to improve the overall scar quality. 21 – 27 …”

“…These studies have proven the safety and efficacy of Botox to improve the eventual appearance of the scar. 1 , 17 , 23 – 27 A controlled prospective randomized clinical trial was conducted by Gassner et al 17 Facial wounds were allocated to receive treatment with either botulinum toxin type A in the study group or normal saline in the control group after wound closure. Photographs and a 10-cm visual analogue scale (zero-worst; ten-ideal) were used to rate the final outcome.…”

“…Other authors have shown that the injection of Botox prior to surgery on the skin will inhibit the se cretion of nor-epinephrine from the sympathetics, and thus increasing the circulatory perfusion with subsequent improvement of the wound healing process. 27 …”