Botulinum toxin in preventing complications of muscle flap reconstruction in spinal cord injury/disease

Study designRetrospective single-centre study on spinal cord injury/disease (SCI/D) persons with spasticity, treated with muscle flaps reconstruction for pressure injury (PI) between July 2013 and January 2022.ObjectivesPI is a common complication in SCI/D. Neuro-muscular (NM) blockade with botulinum toxin-A (BTX) and intrathecal baclofen were used to treat associated spasticity in the reconstruction with muscle flaps, because spasms can lead to flap detachment and failure of the reconstruction, and compared with drug treatment alone or no drug.SettingTertiary Rehabilitation Hospital for SCI/D in Italy.MethodsData were extracted from medical records. The characteristics of the sample were summarized using absolute and percentage frequencies, median and interquartile range or mean +/- standard deviation, as appropriate. Characteristics and outcomes of PI were reported using the PI as the unit of analysis. Categorical variables were compared between groups with and without BTX-NM blockade using the chi-squared test and continuous variables were compared using Mann-Whitney's test. Statistical analyses were carried out using Stata, version 18.0 (StataCorp LLC, 2023).ResultsIn this study of 46 persons with 54 PIs, the treatment of spasticity consisted of medication, BTX-NM blockade and intrathecal baclofen. The use of BTX-NM was associated with a significantly lower minor complication rate (13.4% vs 59%, p = 0.003) and a significantly shorter time to complete recovery (44 vs 58 days, p = 0.006).ConclusionBTX-NM can be used to prevent muscle spasms and may lead to better outcomes by reducing the minor complication rates and time to recovery.