The Safety and efficacy of botulinum toxin type A injection for postoperative scar prevention: A systematic review and meta‐analysis

Yang, Wenhui; Li, Guangxue

doi:10.1111/jocd.13139

Cited by 17 publications

(17 citation statements)

References 26 publications

(87 reference statements)

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“…BTA has been available for clinical use for more than 30 years and its efficacy and safety are well proved. Nowadays, an increasing number of studies have showed that BTA injections inhibit the formation of HS 2‐5 . Moreover, our previously published random clinical trial found that the injection of BTA in the early postoperative could decrease the scar formation, reduce the scar width, and make the overall appearance more satisfactory 6 .…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin type A attenuates hypertrophic scar formation via the inhibition of TGF‐β1/Smad and ERK pathways

Yang

Zheng

et al. 2020

J of Cosmetic Dermatology

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Background: Hypertrophic scar is a common complication in would healing process, and how to effectively prevent and treat it has been a hot and difficult research issue.Previous studies have showed that botulinum toxin type A (BTA) has effects on the prevention and treatment of hypertrophic scar, but little is known about the specific mechanisms.Objective: This study aimed to explore the potential mechanisms of BTA on the inhibition of hypertrophic scar formation.Methods: Hypertrophic scar-derived human fibroblasts were cultured and then treated with transforming growth factor-β1 (TGF-β1) and various concentrations of BTA. Cell proliferation and viability were measured by CellTiter 96® AQueous One Solution Cell Proliferation Assay and trypan blue staining, respectively. The total amount of collagen was examined using Sirius red staining. Collagen I and Collagen III in the culture supernatant were evaluated by enzyme-linked immunosorbent assay.Reverse transcription-quantitative polymerase chain reaction and Western blot analysis were performed to detect the transcription and translation levels.Results: Our results revealed that BTA decreased the proliferation of hypertrophic scar-derived human fibroblasts. The mRNA and protein expression levels of alphasmooth muscle actin, collagen I, and collagen III induced by TGF-β1 were inhibited by BTA in a dose-dependent manner. BTA also inhibited the phosphorylation of Smad2/3 and ERK. Conclusion:BTA decreased the proliferation of fibroblasts and prevented overdeposition of ECM through the inhibition of the TGF-β1/Smad and ERK pathways. The findings of this study provide new scientific reference for the prevention and treatment of hypertrophic scar.

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Section: Introductionmentioning

confidence: 99%

Botulinum toxin type A attenuates hypertrophic scar formation via the inhibition of TGF‐β1/Smad and ERK pathways

Yang

Zheng

et al. 2020

J of Cosmetic Dermatology

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“…Some studies show that BTXA has a significant effect on the prevention of postoperative scars 8,26 . Clinicians have achieved good prophylactic results with BTXA injection near the surgical incision after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…25 Some studies show that BTXA has a significant effect on the prevention of postoperative scars. 8,26 Clinicians have achieved good prophylactic results with BTXA injection near the surgical incision after surgery. Laarakker reported that BTXA is used to salvage ischaemic hand injuries to avoid finger or limb amputation.…”

Section: Comparison Of Vegf Expressionmentioning

confidence: 99%

“… 5 BTXA is now used in the clinic, and randomised controlled trials have gradually incorporated BTXA, but the evaluation criteria are limited to morphological indicators, including visual analogue scale (VAS) score, VSS, patient satisfaction, and adverse events. 6 , 7 , 8 The mechanism of BTXA treatment and the stability of its action are still unclear. Therefore, we performed a literature search to identify studies using BTXA in animal models to obtain more detailed morphological and protein expression data and explore the mechanism of BTXA.…”

Section: Introductionmentioning

confidence: 99%

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Safety and efficacy of botulinum toxin type A in preventing and treating scars in animal models: A systematic review and meta‐analysis

Pan

Qin

et al. 2021

International Wound Journal

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Previous studies have used botulinum toxin type A (BTXA) to improve postoperative and hypertrophic scars; however, there is lack of detailed verification on the safety and effectiveness of this approach. This study aimed to evaluate the therapeutic effect of BTXA on postoperative hypertrophic scars and its influence on cytokine expression in animal models. A computerised search of different databases was performed, including PubMed, Web of Science, Scopus, Cochrane, Embase, CNKI, and Wanfang, up to 10 March 2021. A meta-analysis was performed using R 4.0.0 based on hypertrophic index, epithelialisation time, wound area, and vascular endothelial growth factor (VEGF) expression. Eleven studies were included. The meta-analysis showed a significant difference in hypertrophic index (standardised mean difference [SMD] = À2.63, 95% confidence interval [CI]: À3.50 to À1.76, P < .01), wound area (SMD = À0.54, 95% CI: À1.24 to 0.16, P < .01), and VEGF expression (SMD = À2.56, 95% CI: À3.50 to À1.62, P < .01). This study shows that BTXA is safe and effective in preventing and treating scar hypertrophy in animal models, but excessive doses of BTXA and BTXA to treat large areas should be avoided. K E Y W O R D S animal model, botulinum toxin type A, scar Key Messages • we observed a significant difference in hypertrophic index (standardised mean difference [SMD] = À2.63, 95% confidence interval [CI]: À3.50 to À1.76, P < .01), wound area (SMD = À0.54, 95% CI: À1.24 to 0.16, P < .01), and VEGF expression (SMD = À2.56, 95% CI: À3.50 to À1.62, P < .01) between BTXA-treated groups and control groups

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“…Zhang et al 37 performed a meta-analysis in 2016; however, 2 of the studies 38,39 included in this analysis were not RCTs, and the experimental group of 1 study was BTXA combined with intense pulsed light. In 2019, Yang et al 40 conducted a meta-analysis; however, most of the studies included in this analysis were published in Chinese, and no sensitivity analysis was performed. Previous systematic reviews have not reached a consensus on BTXA in the prevention of scarring.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis

Zhang

2020

J Cutan Med Surg

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Background Scars with poor cosmesis that develop after wound healing may affect normal life. Objective To assess the efficacy and safety of botulinum toxin type A (BTXA) in preventing postoperative hypertrophic scars or keloids. Methods A systematic review was performed by searching the PubMed, Cochrane Library, and EMBASE databases from their inception date up to February 2020 for randomized controlled trials (RCTs) evaluating the efficacy of BTXA in preventing hypertrophic scars or keloids. The primary outcome measures included the Vancouver Scar Scale (VSS) score, Visual Analog Scale (VAS) score, scar width, patient satisfaction, and adverse events. Results Twelve RCTs involving 497 cases (372 patients) were included. The meta-analysis showed significant differences in the VAS score (weighted mean difference [WMD] = 1.31, 95% CI = 1.06 to 1.55, P < .00001), VSS score (WMD = −1.02, 95% CI = −1.72 to −0.32, P = .004), scar width (WMD = −0.18, 95% CI = −0.29 to −0.08, P = .0008), and patient satisfaction (relative risk = 1.25, 95% CI = 1.06-1.49, P = .01). Four studies reported trivial adverse events. Conclusions This meta-analysis showed that BTXA was more effective than the control treatment in preventing postoperative scars and improving the cosmetic appearance of facial scars for East Asians, and no serious adverse events were found during the follow-up period. However, there was insufficient evidence to support the use of BTXA for the prevention of scars in patients from other ethnic groups and regions or scars in non-facial areas.

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The Safety and efficacy of botulinum toxin type A injection for postoperative scar prevention: A systematic review and meta‐analysis

Cited by 17 publications

References 26 publications

Botulinum toxin type A attenuates hypertrophic scar formation via the inhibition of TGF‐β1/Smad and ERK pathways

Botulinum toxin type A attenuates hypertrophic scar formation via the inhibition of TGF‐β1/Smad and ERK pathways

Safety and efficacy of botulinum toxin type A in preventing and treating scars in animal models: A systematic review and meta‐analysis

Efficacy and Safety of Botulinum Toxin Type A in Preventing Postoperative Scars and Improving the Cosmetic Appearance of Scars: A Systematic Review and Meta-Analysis

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