Global Journal of Medical Research, I: Surgeries and Cardiovascular System, Volume 22 Issue 2

Traumatic Facial Injury Treated by Botulinum Toxin A 47 Year 2022 Global Journal of Medical Research Volume XXII Issue II Version I ( D ) I © 2022 Global Journals invisible scars. Treatment with BTA was proposed for the treatment of hypertrophic scars and keloids in 2014 and 2015 9, 10 . We have used this technique to treat scars since 2011 (the first case mentioned in this study). Movement produces tension on the edge of the wound, which can be avoid injecting BTA in the region, thus reducing muscle contraction, skin tension, microtrauma, and inflammatory process 11 . BTA reduce the expression of transforming growth factor-beta, which is the main regulator of the formation of hypertrophic scarring 3 . Kim YS et al performed a split-scar, double- blind, randomized, controlled study on 15 patients with early post-thyroidectomy scars. After six months they found a significant improvement in 50% of the scar, comparing the BTA area to the 0.9% saline area 12 . The study of Shaarawy E. et al shows BTA more effective in reducing pruritus and keloid-related pain than intralesional corticosteroids where used to preventing hypertrophic scar 13 . Moreover, the 3D profilometry used to objectively assess keloids treated with BTA showed a lack of results in some surgical cases. Some clinical studies did not support variations in TGF-beta or fibroblasts after the treatment of scars with BTA. Thus, there are conflicting results from points of view available, and further studies are needed to assess the specific role of BTA in the healing phisiology 14 . BTA acts during two to six performing temporary chemodenervation by acting on the presynaptic neuron, blocking the release of acetylcholine, leading to functional denervation of the striated muscle 15 . Regarding of the functional effects of the BTA scar formation maybe takes few months, and our observations of final results depended on the end of the histopathological healing process. Predictably, the effects of BTA on the maturation of the scar may take more than one month to be visible. Our evaluation, satisfaction and measurement data, demonstrate that the injection of Botulinum Toxin A has a positive effect on scars. Ziade et al validated scar assessment scales evaluate the healing (texture, size, and color) results of complex wounds, but not to be used in simple facial wounds 16 . Injection of BTA improved significantly the discoloration of the scar. Skin lesions invoke an inflammatory response influencing cellular mediators acting over melanocytes and melanogenesis in several ways. The release of nitric oxide, histamine, p53, and transforming growth factor b1 (TGF-b1) by the inflammatory process induces melanogenesis 17 . Post-inflammatory hyperpigmentation is still unclear, it is believed that activation of melanocytes is involved through oxidative species and inflammatory mediators by skin wounded 18 . Since the damage to the skin is caused by repeated microtrauma due to the movement of the injured tissue (skin traction), it provokes a prolonged release of peptide related to the calcitonin gene and substance P, in addition to the cleavage of the SNAP25 protein, by injection of BTA 19 . With these factors together we can observe that the stress-relieving properties of BTA added to its inhibiting effects on inflammation support the use of the drug in preventing scarring. IV. C onclusion Botulinum toxin A is efficient for the treatment and reduction of facial scars resulting from trauma or surgical interventions. This study shows a reduction in the size and pigmentation of scars in patients who were treated with a perilesional injection of BTA, which may be a choice method for avoiding or treat hypertrophic scars and keloids in areas of muscle tension. This study demonstrates good clinical effects of BTA in the treatment and prevention of hypertrophic scars and keloids. R eferences R éférences R eferencias 1. Lee SH., Min HJ., Kim YW., et al. The Efficacy and Safety of Early Postoperative Botulinum Toxin A Injection for Facial Scars. Aesthetic Plastic Surgery, 2017; 42(2), 530–537. Doi: 10.1007/s00266-017- 1008-7. 2. Kasyanju Carrero LM., Ma WW., Liu HF., et al. Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review. Journal of Cosmetic Dermatology, 2018 . Doi: 10.1111/jocd.12828. 3. Elhefnawy AM. Assessment of intralesional injection of botulinum toxin type A injection for hypertrophic scars. Indian J DermatolVenereolLeprol , 2016; 82(3): 279–283. Doi: 10.4103/0378-6323.173586. 4. Guida S., Farnetani F., Nisticò SP., et al. New trends in botulinum toxin use in dermatology. DermatolPract Concept, 2018; 8(4): 277–282. Published 2018 Oct 31. Doi: 10.5826/ dpc.0804a05. 5. Heffelfinger R., Sanan A., Bryant LM. Management of Forehead Scars . Facial Plastic Surgery Clinics of North America, 2017; 25(1), 15–24. Doi: 10.1016/ j.fsc. 2016. 08.012. 6. Padulla GA., Bagatin E., Hirata SH., et al. Effect of botulinum toxin type A on the healing of facial skin biopsies - series of cases. An Bras Dermatol , 2018; 93(4): 610–611. Doi: 10.1590/abd1806-4841.2018 7425. 7. Schlessinger J., Gilbert E., Cohen JL., et al. New Uses of Abobotulinumtoxin A in Aesthetics. Aesthetic Surgery Journal , 2017; 37(suppl_1), S45– S58. Doi: 10.1093/asj/sjx005. 8. Due E., Rossen K, Sorensen LT., et al. Effect of UV irradiation on cutaneous cicatrices: a randomized,