| Background Surgical scars,particularly those located on the exposed parts of the body,can be quite distressing.The cosmetic outcome of anterior neck scars in thyroidectomy has been of particular interest because of their location and the female predominance among thyroidectomy patients.Despite the high demand for an early intervention to minimize surgical scars,there is yet no universal consensus on the optimal treatment of hyperproliferative scars.The tension vectors acting on the wound edges are transmitted to immature collagen fibers synthesized during the normal healing phase.This accounts for scar widening as well as hypertrophic and hyperpigmented scars.A number of studies have demonstrated that early intralesional injections of botulinum toxin type A(BTXA)induces temporary muscular paralysis,decreases tension vectors on wound edges and significantly enhances wound healing.The timing of the injection of BTXA is an important factor in the effect the toxin has on scar cosmesis.Therefore,we conducted this trial to compare the two time points of toxin injection to investigate whether earliest of intervention has better scar outcome.Objective A prospective,double-blind randomized controlled trial held to assess the most suitable time for the administration of intralesional BTXA injection in anterior cervical incisional scar in patients undergoing thyroidectomy,by comparing the scar outcome and efficacy by injecting the BTXA right after skin closure and after 7 days postoperatively,in a single institution.Patients and methods Thirty-four patients undergoing thyroidectomy,receiving anterior cervical incision were enrolled in this study and randomized into two groups,either receiving the toxin immediately after skin closure or after 7 days postoperatively.16 patients in the ‘immediate toxin' group and 18 patients in the ‘late toxin' group both underwent two sessions of injection,once with botulinum toxin A and once with 0.9% NS,alternatively at two different time points.Scars were assessed by two independent blinded and experienced evaluators using the Stony Brook Scar Evaluation Scale(SBSES),at baseline and 90 days follow-up visit,and with Visual Analogue Scale(VAS)using standardized photographs at 90 days follow-up.At 90 days follow-up visit,patients also evaluated their own scars using a 5-point satisfaction scale.Results At the 90 days' visit,a total of 27 patients were reviewed.2 patients in ‘immediate-toxin' group,and 5 patients in the ‘late-toxin' group were lost to follow-up.There was statistically significant improvement in modified SBSES in the immediate-toxin group with 0.86 ± 1.41 mean increase from baseline to 90 days' visit(p = 0.040).However,in the late-toxin group,the modified SBSES mean decreased with-1.27 ±1.48 from baseline to 90 days' visit(p = 0.009).The median VAS rated by the two evaluators was 6.43(2.50,9.50)for the immediate-toxin group compared with 4.85(3.00,9.00)for the late-toxin group.This result was statistically different demonstrating significant improvement in the scar outcome in the immediate-toxin group(p = 0.042).At 90 days' visit,out of the 14 patients in the immediate-toxin group,50% were very satisfied,14.29% satisfied,21.43% slightly satisfied,7.14% unsatisfied,and 7.14% were very unsatisfied.Whereas out of 13 patients in the late-toxin group,23.08% were very satisfied,15.38% satisfied,7.69% slightly satisfied,30.77% unsatisfied,and 23.08% very unsatisfied with the quality of the scar.Conclusions The chemo-immobilization attributable to injections of BTXA appears to improve cosmesis of anterior neck scars.BTXA injection administered immediately at the time of skin closure was far superior and the most effective in modulating anterior cervical incisional scars and seems to be a promising option for scar prevention.This study concluded that the timing of administration of Botulinum Toxin A injection was a very important factor when treating anterior cervical incisional scars with BTXA. |
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