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Abstract
BackgroundMost patients with facial scarring would value even a slight improvement in scar quality. Botulinum toxin A is widely used to alleviate facial dynamic rhytides but is also believed to improve scar quality by reducing wound tension during healing. The main objective was to assess the effect of Botulinum toxin on scars resultant from standardized upper lip wounds.MethodsIn this double-blinded, randomized, vehicle-controlled, prospective clinical trial, 60 consecutive consenting adults undergoing cleft lip scar revision (CLSR) surgery between July 2010 and March 2012 were randomized to receive botulinum toxin A (n = 30) or vehicle (normal saline; n = 30) injections into the subjacent orbicularis oris muscle immediately after wound closure. Scars were independently assessed at 6-months follow-up in blinded fashion using: Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) and photographic plus ultrasound measurements of scar widths.Results58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group.ConclusionQuality of surgical upper lip scars, which are oriented perpendicular to the direction of pull of the underlying orbicularis oris muscle, is significantly improved by its temporary paralysis during wound healing.Trial RegistrationClinicalTrials.gov NCT01429402
Highlights
A cutaneous scar is the end result of a complex wound healing process that follows dermal injury [1, 2]
Scars were independently assessed at 6-months follow-up in blinded fashion using: Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) and photographic plus ultrasound measurements of scar widths
Skin tension that is perpendicular to an incision or laceration is known to increase the risk of unfavorable scarring as a result of the distracting forces exerted on the healing wound [4]
Summary
A cutaneous scar is the end result of a complex wound healing process that follows dermal injury [1, 2]. The characteristic shape, location and orientation of a cheiloplasty scar mark the patient for life as having been born with a cleft lip deformity. Botulinum toxin A is widely used to alleviate facial dynamic rhytides but is believed to improve scar quality by reducing wound tension during healing. Methods: In this double-blinded, randomized, vehicle-controlled, prospective clinical trial, 60 consecutive consenting adults undergoing cleft lip scar revision (CLSR) surgery between July 2010 and March 2012 were randomized to receive botulinum toxin A (n530) or vehicle (normal saline; n530) injections into the subjacent orbicularis oris muscle immediately after wound closure. Conclusion: Quality of surgical upper lip scars, which are oriented perpendicular to the direction of pull of the underlying orbicularis oris muscle, is significantly improved by its temporary paralysis during wound healing.
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