Preoperative botulinum toxin A injection in complex abdominal wall reconstruction- a propensity-scored matched study.
INTRODUCTION
Fascial closure during complex abdominal wall reconstruction (AWR) improves recurrence and wound infection rates. To facilitate fascial closure in massive ventral hernias preoperative Botulinum Toxin A (BTA) injection can be used.


METHODS
2:1 propensity-scored matching of patients undergoing AWR with and without BTA was performed based on BMI, defect width, and loss of domain using CT-volumetric analysis.


RESULTS
145 patients without BTA and 75 with BTA were comparable on hernia size (240vs251cm2, p = 0.589) and hernia volume (1405vs1672cm3, p = 0.243). Patients with BTA had higher wound class (CDC≥3 37%vs13%, p < 0.001). Patients with BTA had a higher fascial closure rate (92%vs81%, p = 0.036), received more components separation (61%vs47%, p = 0.042), lower wound infection rate (12%vs26%,p = 0.019) and comparable recurrence rates (9%vs12%, p = 0.589). Recurrences occurred more often without complete fascial closure compared to patients with (33%vs7%, p < 0.001).


CONCLUSION
In patients with massive ventral hernias and severe loss of domain, preoperative BTA-injection improves fascial closure rates during AWR.
['Deerenberg|Eva Barbara|EB|', 'Shao|Jenny Meng|JM|', 'Elhage|Sharbel Adib|SA|', 'Lopez|Robert|R|', 'Ayuso|Sullivan Armando|SA|', 'Augenstein|Vedra Abdomerovic|VA|', 'Heniford|B Todd|BT|']
D034861:Abdominal Wall D058107:Abdominal Wound Closure Techniques D015992:Body Mass Index D019274:Botulinum Toxins, Type A D054893:Cone-Beam Computed Tomography D000071938:Fasciotomy D005260:Female D006555:Hernia, Ventral D059685:Herniorrhaphy D006801:Humans D008297:Male D008875:Middle Aged D009465:Neuromuscular Agents D011300:Preoperative Care D057216:Propensity Score D019651:Reconstructive Surgical Procedures D012008:Recurrence D013530:Surgical Wound Infection
Botulinum toxin a Complex abdominal wall reconstruction Recurrence Ventral Hernia Incisional