Abstract
Use of botulinum toxin type A in first intention healing wounds has been widely adopted in order to inhibit the formation of hypertrophic scars. In this report we demonstrate the use of the toxin in a surgical wound left to heal by secondary intention, after the removal of a squamous cell carcinoma in situ by Mohs micrographic surgery in supralabial region, with good cosmetic result. Botulinum toxin acts by inhibiting the proliferation of fibroblasts, by differentiating fibroblasts and by producing type I collagen, which are the main factors responsible for the good quality of the healing process.
Highlights
Scars are a major concern for patients, especially if located in the face.[1]
Another finding presented in same study was the suppression of the differentiation of fibroblasts into myofibroblasts, which are responsible for the acceleration of the wound contraction process, by inhibiting the expression of TGF-β1
Analyses of reverse transcription reaction in polymerase chain demonstrated decreased levels of smooth muscle alpha-actin’s mRNA in cells treated with TGF-β1 associated with botulinum toxin type A, when compared to cells treated only with TGF-β1. 3
Summary
Scars are a major concern for patients, especially if located in the face.[1]. They are unavoidable consequences of surgical treatments in general.[1]. After undergoing endocytosis at the nerve terminal, the toxin promotes inhibition of acetylcholine release at the neuromuscular junction, suppressing muscle contraction for a period of two to six months. The authors describe the case of intraoperative application of botulinum toxin followed by secondary intention healing, with excellent aesthetic results. Eight units of botulinum toxin type A were applied in the surgical wound, leaving to heal by secondary intention. Eighteen days after the surgery there was complete healing of the wound, with the formation of a slightly erythematous cicatricial tissue in the upper lip and a discreet extension into the supralabial region (Figure 3).The resulting appearance remained in the late 3-month postoperative period, with excellent aesthetic and functional outcomes (Figure 4 A and B)
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