Resultado de la aplicación preoperatoria de toxina botulínica A en el tratamiento de hernias incisionales gigantes

Chávez-Tostado, Karla Verónica; Cárdenas-Lailson, Luis Eduardo; Pérez-Trigos, Haydée

doi:10.1016/j.rehah.2014.06.001

Cited by 30 publications

(14 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bueno-Lledo and colleagues reported the pre-operative injection of BTA for large incisional hernia repairs under EMG and ultrasound guidance (16) but did not describe any subsequent post-operative role for EMG. Other groups made use of EMG during BTA injection aiming to identify the location of maximal muscle activity (6, 17). Rodriguez-Acevedo et al demonstrated that there was no statistically significant difference in muscle elongation gain per side between the therapeutic effect of a 300 units and 200 units dose of BTA (15).…”

Section: Discussionmentioning

confidence: 99%

Limitations of Electromyography in the Assessment of Abdominal Wall Muscle Contractility Following Botulinum Toxin A Injection

Martins¹,

Elstner²,

Skulina

et al. 2019

Front. Surg.

View full text Add to dashboard Cite

Purpose: Pre-operative botulinum toxin A (BTA) injection of the lateral obliques aims to facilitate the closure of large ventral hernia defects and decrease the risk of repair breakdown during the critical healing phase. The exact duration of post-operative BTA effect and top-up timing in cases at high risk of recurrence remains uncertain. This study was designed to assess the value of electromyography (EMG) in determining the appropriate time for BTA top-up. Methods: 56 patients underwent ventral hernia repair with pre-operative BTA infiltration of the lateral obliques. Eleven patients at high risk of recurrence considered suitable for BTA top-up were assessed post-operatively with both functional computed tomography (CT) and EMG. CT assessed segmental contractility of each muscle layer. Single-point EMG assessed the activity of individual muscle layers bilaterally in the anterior axillary line. Results: CT showed (i) variable contractility of anterior and posterior muscle segments prior to BTA injection ; (ii) absent or incomplete muscle paralysis in over half of all segments; (iii) increased BTA effect on progress scans; and (iv) non-uniform pattern of change in BTA effect between the anterior and posterior muscle. EMG demonstrated modest voluntary activity in most muscle layers. Compared to standard of reference (CT), EMG showed moderate sensitivity (0.62), poor specificity (0.48), poor accuracy (0.57), and incorrect grading in 71% of true positive results. Conclusions: As BTA effect wanes, single-point EMG cannot reliably determine functional muscle status. A novel finding is that BTA-induced paralysis of the abdominal muscles may be remarkably non-uniform in degree, distribution and duration.

show abstract

Section: Discussionmentioning

confidence: 99%

Limitations of Electromyography in the Assessment of Abdominal Wall Muscle Contractility Following Botulinum Toxin A Injection

Martins¹,

Elstner²,

Skulina

et al. 2019

Front. Surg.

View full text Add to dashboard Cite

show abstract

“…In their work, Zielinski et al achieved an 83% rate of fascial closure, which increased to 89% for patients given BTX within 24 h of their index laparostomy (9). Further studies in 2014 (10,11) added to the evidence base for BTX as a potentially useful tool to help abdominal wall closure.…”

Section: Early Developmentmentioning

confidence: 99%

“…Ibarra-Hurtado described 10 patients in which the mean hernia defect had been reduced by a mean of 5.25 cm from an original mean defect size of 13.85 cm (7). Chavez-Tostado et al also analysed reduction in hernia defect width after only 100 IU of BTX but found no significant improvement (10).…”

Section: Clinical Benefits Of Btx Use Muscular Paralysis and Fascial Closurementioning

confidence: 99%

The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure

Whitehead-Clarke

Windsor

2021

Front. Surg.

View full text Add to dashboard Cite

Abdominal wall surgeons have developed a host of tools to help facilitate fascial closure. Botulinum toxin A is one of the most recently identified treatments and has grown in popularity over recent years; showing great promise in a number of case series and cohort studies. The toxin paralyses lateral abdominal wall muscles in order to increase laxity of the tissues—facilitating medialisation of the rectus muscles. Several research groups around the world are developing expertise with its use-uncovering its potential. We present a review of the relevant literature over the last two decades, summarising the key evidence behind its indications, dosing and effects.

show abstract

“…Abdominal wall BT, also described in the literature as chemical component separation, leads to muscular elongation and reduction of the thickness of the lateral abdominal wall [19], less postoperative pain [15,20], lower incidence of compartment syndrome, and ventilatory/respiratory complications. The injection of BT leads to 30-50% reduction on the abdominal defect and of the area of the hernia defect after 3-4 weeks [1,4,7,17] and elongates about 2.4-4.1 cm/side of the wall (transversely), in adults [1,13]. Some propose that BTI may also be used preemptively to avoid postoperative ventral hernias in high-risk selected cases [2].…”

Section: Bti Previous To the Repair Of Cihmentioning

confidence: 99%

“…Doses and injection volumes vary from 100 [7] to 500 IU [10] (Table 2). Dysport© doses should be calculated as 3 times the doses of Botox©.…”

Section: Bti Previous To the Repair Of Cihmentioning

confidence: 99%

Botulinum toxin abdominal wall injection and post-omphalocele ventral hernia repair: database and proposal of a protocol

et al. 2020

View full text Add to dashboard Cite

Background Post-omphalocele ventral hernias (POVH) are common after giant omphaloceles. Abdominal wall botulinum toxin injections (BTI) are useful to treat complex incisional hernias (CIH) in adults, which may also apply to POVH. We review BTI data in the treatment of CIH and POVH and propose an algorithm applicable to POVH. Results Sixteen papers which described the treatment of CIH on the treatment of POVH in adults (n = 15) and children (n = 1) were reviewed. BTI elongates the lateral abdominal wall and reduces the hernia defect, with a lower incidence of compartment syndrome and respiratory complications. Doses and injection volumes vary. Effects start after 3 days, peak after 10–15 days, stabilize for 2–3 months, and decline after 4–6 months, disappearing after 6–9 months. Patients should be operated on 3–4 weeks after injection. Post-operative complications are uncommon. BTI may be associated with pre-operative pneumoperitoneum (PPP). Children presenting POVH differ from adults presenting CIH. Associated congenital cardiac malformations, genetically determined syndromes, pulmonary hypoplasia, abdominal wall hypoplasia, and thoracic dysmorphism, are common; children need sedation for any procedures; non-absorbable reinforcing meshes are not indicated; and POVH limits are frequently near to the costal margin. Conclusion BTI to induce preoperative muscular relaxation in preparation of CIH repair in adults is effective and safe. Experience with the method in children with POVH is limited, but the proposal is logical and probably safe. POVH differs from CIH in some aspects, especially abdominal wall hypoplasia, proximity to the rib cage, and diaphragmatic biomechanics.

show abstract

Resultado de la aplicación preoperatoria de toxina botulínica A en el tratamiento de hernias incisionales gigantes

Cited by 30 publications

References 8 publications

Limitations of Electromyography in the Assessment of Abdominal Wall Muscle Contractility Following Botulinum Toxin A Injection

Limitations of Electromyography in the Assessment of Abdominal Wall Muscle Contractility Following Botulinum Toxin A Injection

The Use of Botulinum Toxin in Complex Hernia Surgery: Achieving a Sense of Closure

Botulinum toxin abdominal wall injection and post-omphalocele ventral hernia repair: database and proposal of a protocol

Contact Info

Product

Resources

About