Nonsurgical Delay of Dorsal Rat Cutaneous Flap Using Botulinum Toxin Type A

Yildirim, Alpagan Mustafa; Okur, İhsan; Örter, Zübeyir; Uysal, Ata

doi:10.1097/prs.0b013e3181774745

Cited by 10 publications

(11 citation statements)

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“…As expected, the local BoTA application significantly decreased the necrotic flap area when compared to that in the control group. This result agreed with previous studies on the effects of BoTA in skin flaps [15–18]. We think that BoTA may protect against IR injury at the cellular level, even beyond its vasodilatation and increased flap circulation capabilities.…”

Section: Discussionsupporting

confidence: 93%

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The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model

Park

2017

BioMed Research International

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Introduction While studies using various materials to overcome ischemia-reperfusion (IR) injury are becoming increasingly common, studies on the effects of botulinum toxin A (BoTA) on IR injury in musculocutaneous flaps are still limited. The purpose of this study was to examine our hypotheses that BoTA provide protection of musculocutaneous flap from ischemia-reperfusion injury. Method Five days after pretreatment injection (BoTA versus normal saline), a right superior musculocutaneous flap (6 × 1.5 cm in size) was made. Ischemia was created by a tourniquet strictly wrapping the pedicle containing skin and muscle for 8 h. After ischemia, the tourniquet was cut, and the musculocutaneous flap was reperfused. Results The overall survival percentage of flap after 8 h of pedicle clamping followed by reperfusion was 87.32 ± 3.67% in the control group versus 95.64 ± 3.25% in the BoTA group (p < 0.001). The BoTA group had higher expression of CD34, HIF-1α, VEGF, and NF-kB comparing to control group in qRT-PCR analysis. Conclusions In this study, we found that local BoTA preconditioning yielded significant protection against IR injury in a rat musculocutaneous flap model.

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Section: Discussionsupporting

confidence: 93%

“…Recently, BoTA has been used in experimental studies and noted for its positive effects on flap survival [15–18, 25–27]. Exactly what mechanism is involved in increasing flap viability has not yet been clearly elucidated, but there are several intriguing hypotheses.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model

Park

2017

BioMed Research International

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“…Progressively, perivascular application of BoTA increased the vessel diameter, tissue blood supply and subcutaneously increased flap viability compared to the control group (15). In the experimental study, increase in vessel diameters and angiogenesis was shown by histologic observation (16,17). Schweizer et al (30) demonstrated that BoTA application to the vascular pedicle of an axial pattern flap leads to better flap perfusion, oxygenation, and flap viability.…”

Section: Discussionmentioning

confidence: 96%

“…BoTA increases flap viability by reducing the innervation of the related muscle and having a positive effect on the mobility of the muscle flaps (14). Progressively, perivascular application of BoTA increases the vessel diameter, tissue blood flow, and flap viability (12,13,15); this can be as a result of structural changes in vessels and activated angiogenesis as shown by histological studies (16)(17)(18). Flap survival, in these flap studies, was evaluated by various methods such as scintigraphy, photographic and histological analyses.…”

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confidence: 99%

Effect of Botulinum Toxin-A Injected to Muscle Tissue on Perfusion and Survival of Fasciocutaneous Single Perforator-pedicled Propeller Flap in Rats

2020

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Background: In plastic surgery practice, fasciocutaneous singleperforator-pedicled propeller flap is a preferred procedure; however, its survival rate is below than expected, especially in flaps with a big rotation arc. When botulinum toxin-A is injected into the muscle tissue that the perforator pedicle is arisen, the tonus of pertinent muscle can reduce and the blood flow of its perforator pedicle can increase. Therefore this procedure can improve the survival rate of single-perforator-pedicled propeller flap. Aims: To evaluate the effect of botulinum toxin-A injected with ultrasonographic guidance into the muscle tissue that the perforator pedicle is arisen from one month ago on the perfusion of flap scintigraphically and the survival rate of single-perforator-pedicled propeller flap in a rat model. Study Design: Animal experiment. Methods: Three study groups were receiving botulinum toxin-A (16 IU-0.4 mL), normal saline (0.4 mL), and no study drug one month ago before flap surgery. Injections were performed under ultrasonography guidance. Flaps were elevated fasciocutaneously over the right 2 nd perforator pedicle, under the corneous, with a surgical loupe and microsurgery tool and were rotated clockwise 180°. Then the scintigraphic measurements were obtained after flap elevations in the study groups, including the whole-body and flap perfusions in the study rats. The involvement rate presents the ratio of flap perfusion to whole-body perfusion. Flaps were sutured back to the abdominal wall at the latest twisting angles. With standard photographs taken in all the groups on day 8 after the operation, whole and necrotic flap areas were calculated. Results: Scintigraphically the involvement rate (the ratio of flap perfusion to whole-body perfusion) of the flaps in the botulinum toxin-A group were found significantly higher than those in the other groups (p<0.05). The area of a flap in the botulinum toxin-A group on day 8 post flap suturing was found to be significantly higher than those in the other groups (p<0.05). The area of a necrosis and the percentage of necrosis on day 8 post flap suturing in the botulinum toxin-A group was found significantly lower than those of the sham and null groups (p<0.05). Conclusion: In a rat model, if with the ultrasonographic guidance, botulinum toxin-A is injected to the muscle which perforator of the prospective single-perforator-pedicled propeller flap originated and flap surgery is performed one month later after this injection, the perfusion of single-perforator-pedicled propeller flap increases scintigraphically and this improves flap survival and reduces its necrosis.

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“…Recently, several papers reported the offlabel use of BoNT-A in RP, achieving both symptomatic and functional improvements [2]. Moreover, experimental studies described a beneficial effect on flap vascularization and survival, although all limited to animal models [3,4]. As a consequence, pre-operative BoNT-A injection may be a valuable tool to achieve safer reconstruction when performing digital flaps in patients affected by RP, with the added bonus of symptomatic improvement.…”

Section: Introductionmentioning

confidence: 99%

The use of Botulinum Toxin in digital reconstruction of patients affected by Raynaud’s phenomenon: a case report

Segreto¹,

Marangi²,

Alessandri‐Bonetti³

et al. 2018

The Great Imposture: Eosinophilic Cholangitis

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Background: Surgical reconstruction in patients affected by Raynaud's phenomenon is a challenging procedure due to the vascular impairment, which prevents flap survival and secondary healing. Botulinum Neurotoxin-A showed vasodilatatory and angiogenic properties in animal studies, increasing blood flow in flap surgery. Case presentation: We report an off-label application of Botulinum Neurotoxin-A used for digital reconstruction in a patient affected by Reynaud's phenomenon, in order to enhance flap survival and avoid digital amputation. Complete flap survival and symptomatic relief were achieved. Conclusions: This new approach may be extremely valuable when performing flap reconstruction in patients affected by RP, allowing for increased vascular safety as well as symptomatic improvement.

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Nonsurgical Delay of Dorsal Rat Cutaneous Flap Using Botulinum Toxin Type A

Cited by 10 publications

References 0 publications

The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model

The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model

Effect of Botulinum Toxin-A Injected to Muscle Tissue on Perfusion and Survival of Fasciocutaneous Single Perforator-pedicled Propeller Flap in Rats

The use of Botulinum Toxin in digital reconstruction of patients affected by Raynaud’s phenomenon: a case report

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