Comparison Of Efficacy Of Botulinum Toxin Type A And Silicone Gel Sheeting In Preventing Hypertrophic Scarring After Facial Trauma Debridement And Suture

Objective Facial scarring associated with trauma can have a profound impact on a patient’s mental health and quality of life.Silicone gel sheeting are currently the first choice for preventing hypertrophic scars.We recommend silicone gel sheeting（SGS）for patients who want to prevent obvious scars after emergency debridement and suture surgery for facial trauma,but there are many limitations in the clinical use of such products.Recent studies have shown that botulinum toxin type A（BTA）has anti-hypertrophic scar properties through mechanisms including reducing wound tension,reducing collagen production and inhibiting fibroblast growth.In the hands of experienced surgeons,botulinum toxin type A has been shown to be a safe adjunctive treatment for skin lacerations.So far,there have been no comparative studies of the two drugs.Therefore,we determined and compared the effectiveness of injection of botulinum toxin type A and topical silicone gel sheeting in preventing hypertrophic scarring from facial trauma.Methods According to the inclusion and exclusion criteria,a total of 73 patients with forehead laceration who were treated in the plastic surgery department of our hospital from July 2020 to November 2020 were selected as the research objects.The patients were randomly divided into BTA group（n=24）,SGS group（n=24）or control group（n=25）according to the random number table method.All patients were debridement and suture by the same plastic surgeon.The BTA group was injected with botulinum toxin type A during the operation,the SGS group was treated with a silicone gel film for six months after one week of suture removal,and the control group was treated with simple surgery without special treatment.After 6 and 12 months of follow-up,the Modified Vancouver Scar Scale（MVSS）score,Stony Brook Scar Evaluation Scale（SBSES）score and patient satisfaction score were compared among the three groups.Results A total of 66 patients completed the follow-up.All patients’ facial wounds healed well without infection or delayed healing.Follow-up 6 months and 12 months after operation showed that the MVSS scores were in the BTA group0.05）.The SBSES scores were all BTA group>SGS group>control group,and the difference was statistically significant（P<0.05）.Pairwise comparison between groups: at 6 and 12 months after operation,the scores of the two treatment groups were significantly higher than those of the control group（P<0.05）,and there was no significant difference between the scores of the two treatment groups（P>0.05）.At 12-month follow-up,compared with the control group,the patients in the SGS group and the BTA group were more satisfied with the appearance of the scar（P<0.05）,and no significant difference was observed between the two treatment groups（P>0.05）.Conclusion Injection of botulinum toxin type A can effectively prevent facial scar hyperplasia,improve scar appearance,and improve patient satisfaction.The long-term prognosis is not significantly different from that of topical silicone gel sheeting.