【 文献重点摘要 】

Background

Most 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.

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. 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.

Results

58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group.

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.

背景

大多数面部瘢痕患者都会看重瘢痕质量的哪怕是轻微的改善。肉毒杆菌毒素A被广泛用来缓解面部动态韵律，但也被认为通过减少愈合过程中的伤口紧张来改善瘢痕质量。主要目的是评估肉毒毒素对标准化上唇伤口形成的瘢痕的影响。

方法

采用双盲、随机、载体对照、前瞻性临床试验，将2010年7月至2012年3月连续60例接受唇裂瘢痕修复术(CLSR)的成人随机分为A肉毒毒素(N530)和赋形剂(生理盐水；n530)两组，分别在伤口闭合后立即向口轮匝肌注射肉毒毒素A(N530)或赋形剂(生理盐水；n530)。使用温哥华瘢痕评分(VSS)、视觉模拟评分(VAS)和摄影加超声测量瘢痕宽度，在6个月的盲法随访时独立评估瘢痕。

结果

58例患者完成试验。所有疤痕评估方式显示，实验组的瘢痕在统计学上明显好于车辆对照组。

结论

外科上唇瘢痕在伤口愈合过程中出现暂时性瘫痪，与口轮匝肌拉力方向垂直，可明显改善手术后上唇瘢痕的质量。