Botulinum toxin for the prevention and healing of wound scars: A systematic review of the literature

Abstract

E very discontinuity of the skin can influence its architecture and leave a scar. The cosmetic outcome of surgical and wound scars is of great importance for both surgeons and patients. However, it appears that a large number of scars heal pathologically, resulting in hypertrophic scars (HS) or even keloids. It has been suggested that their pathogenesis is synergistic, involving topographical, metabolic, circulatory, immunological and nutritional factors combined with genetic predisposition (1). Mast cells, vascular endothelial growth factor and alterations in fibroblast concentration are suggested to be of great importance in the process of healing (2,3). Many therapeutic and treatment strategies have been suggested to improve the aesthetic result of HS and keloids (4). Several alternative therapies have been suggested including corticosteroid injections, pressure on the scar, Asiatic acid applications or even radiation therapy (5). Recent studies strived to find novel strategies; electroporation combined with bleo-mycin has recently been suggested for resistant keloids as well as a combination of laser and triamcinolone injections (6,7). Botulinum toxin injections are also considered by many studies to be an innovative and efficient therapy for HS and keloids. However, its clinical effectiveness has not yet been established. The purpose of our systematic review was to examine all available evidence that support its use in current clinical practice. METHODS Study design The present study was designed according to the PRISMA guidelines (8). Eligibility criteria were predetermined by the authors. No language or date restrictions were applied during the literature search. All prospective and retrospective observational studies were deemed eligible for inclusion. Case reports were excluded. Two authors (AP and MF) abstracted and tabulated predetermined data to a structured form, while the rest of the authors reviewed them independently.