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Application of Botulinum Toxin Type A in Myocutaneous Flap Expansion

Chenwang, Duan M.D.; Shiwei, Bao M.D.; Dashan, Yu M.D.; Qiang, Li M.D.; Bin, Chen M.D.; Muxin, Zhao M.D.; Pengcheng, Li M.D.; Senkai, Li M.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1450-1457
doi: 10.1097/PRS.0b013e3181b989be
Experimental: Original Articles

Background: Although the use of the expanded myocutaneous flap has many advantages, the time course is prolonged. The net gain in surface area during acute expansion is insufficient. In this study, botulinum toxin type A was applied to shorten the flap expansion period while obtaining an adequate surface area that would meet surgical requirements.

Methods: Seven minipigs were used for the authors’ experiments. Two sides of the dorsolumbar section in each pig were divided randomly into the botulinum toxin type A–treated and the saline-treated groups. Two 200-ml expanders were implanted in the submuscular pocket. Inflation began 2 weeks later, and the period of expansion was observed in a double-blind manner. Two weeks after the final inflation, the expansion area was measured, and a 10 × 6-cm myocutaneous flap was elevated and sutured in situ, and the contraction of the myocutaneous flap was observed.

Results: Botulinum toxin type A shortened the expansion time by 17 days (p < 0.001). The average increment of effective expansion area (p = 0.009) and the average recruitment area (p = 0.001) in the botulinum toxin type A–treated group were significantly higher than in the saline-treated group. Moreover, contraction in axial length and width of the botulinum toxin type A–treated group was lower than that of the saline-treated group at each time point following transposition (p < 0.001).

Conclusions: Botulinum toxin type A could decrease the resistance to myocutaneous flap expansion, speed up the inflation, increase the expansion area, and reduce the contraction of the myocutaneous flap. It is a safe and convenient method with which to assist myocutaneous flap expansion.

Tangshan and Beijing, People’s Republic of China

From the Tangshan Worker’s Hospital, Hebei Medical University; Beijing Hospital, Chinese Ministry of Health; Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science; and No. 2 Hospital affiliated to General Hospital of the Chinese People’s Liberation Army.

Received for publication March 25, 2009; accepted May 7, 2009.

Disclosure: None of the authors has a financial interest to disclose in relation to the content of this article.

Li Senkai, M.D., Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu Road, Shijingshan District, Beijing 100144, People’s Republic of China,

©2009American Society of Plastic Surgeons