Early postoperative treatment of thyroidectomy scars using botulinum toxin: A split‐scar, double‐blind randomized controlled trial

Abstract

Operational scars, especially those located on the exposed parts of the body, can be distressing. Despite high demand for an early intervention to minimize surgical scars, there is yet no universal consensus on optimal treatment. A split-scar, double-blind randomized controlled trial was held to assess the safety and efficacy of early postoperative botulinum toxin type A (BTA) injection in surgical scars. A single session of treatment was performed where BTA was allocated to one half of the scar and 0.9% saline to the control half. Scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES) with standardized photographs. Fifteen patients completed the study, and their data were analyzed. At 6 months' follow-up, a significant improvement in SBSES score was noted for the BTA-treated halves of the scars (p < 0.001), with minimal change on the saline-treated side (p = 0.785). The mean calculated difference in SBSES scores (final/initial) between the BTA-treated side and the saline-treated side was also significant (p < 0.001). Early postoperative BTA injection was safe and effective in modulating thyroidectomy scars and may be a promising option for scar prevention.

Botulinum toxin type A for the treatment and prevention of hypertrophic scars and keloids: Updated review

“…Each of the patients’ scar was divided in half, each half received either BoNT‐A or saline injection. On the 6 months follow‐up, there was statistically difference in scar appearance in all 15 patients that completed the study between the side that received BoNT‐A injection and the side that received normal saline injection …”

The Safety and efficacy of botulinum toxin type A injection for postoperative scar prevention: A systematic review and meta‐analysis

“…A total of 7 studies reported patient satisfaction (Figure ), of which, the study of Wang Yang et al used the questionnaire survey covering scar hypertrophy, recovery progress, discomfort, ecchymosis, and psychological impact; the study of Xu Zhigang et al used a 10‐point value to evaluate the scar of patients, which were not included in this comparison due to the lack of specific data; The remaining five studies used “very satisfied,” “satisfied,” “slightly satisfied” and “dissatisfied”, or “satisfied,” “average” and “dissatisfied” for rating. We defined the percentage of the sum of options other than the “dissatisfied” in the total number as patient satisfaction, and the heterogeneity test suggested limited heterogeneity between studies ( χ 2 = 3.30, P = .51, I 2 = 0%＜50%), so the fixed effect model was adopted, RR = 1.19[95％CI:(1.11,1.29), P ＜ .00001]; The results showed that there was significant difference in patient satisfaction between the two groups, among which the patient satisfaction in the BTXA group was significantly higher than that in the control group.…”

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

“…Kim et al (14) included 15 patients >18 years of age with a recent (<10 days) thyroidectomy neck scar with a mean length of 8 cm in a randomized, controlled split-scar study. Excluded were patients who were allergic to botulinum toxin, pregnant or lactating, suffering from myasthenia, injected with the toxin in the previous six months and those who refused to participate.…”

“…The randomization was based on a generator setting the left or right side with number 0 or 1. Both the patients and the dermatologist performing the injections were blinded, while the other examiners were absent from the injection room (14).…”

“…The main weakness of our systematic review relies on the low methodological quality of the included trials. The number of enrolled participants is relatively small and underpowered; furthermore, with the exception of three trials (14,17,22), the majority were uncontrolled studies. A very significant disadvantage of these studies is that the assessment of the effect of BTA is mainly based on the patients' perception of wound healing (24), although some trials used objective scales such as the OSAS, the VSS and the VAS (17).…”