Decreased utilization of component separation techniques over time in complex abdominal wall reconstruction following introduction of preoperative botulinum toxin A

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2026-06-01 Epub Date: 2026-03-06 DOI:10.1016/j.amjsurg.2026.116919

Samantha W. Kerr , William R. Lorenz , Victoria L. Walker , Robert R. Lopez , Robert J. Raible , Lucy Hinton , Alexis M. Holland , Gregory T. Scarola , Kent W. Kercher , Vedra A. Augenstein , B. Todd Heniford , Sullivan A. Ayuso

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引用次数: 0

Abstract

Introduction

Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculature, potentially reducing CST. This study evaluated trends in CST utilization following the adoption of BTA.

Methods

A prospectively maintained database was reviewed for patients who underwent open AWR (2016-2024). Primary outcome was proportion of CST use over time; secondary analysis compared early (2016-2017) versus late (2023-2024) cohorts.

Results

Among 1484 patients (mean age 58.8 ± 12.3 years; BMI 31.0 ± 5.8 kg/m²; defect size 211.5 ± 165.6 cm²), fascial closure was achieved in 99.5%. CST decreased from 48.0% to 19.9% (OR: 0.88,95% CI: 0.813,0.946;p < 0.001). BTA increased (2.9% to 11.0%), though annual change was not significant (OR: 0.98,95% CI: 0.898,1.071;p = 0.670). Between early and late cohorts (n = 384 vs. 356), defect size was similar (219.1 ± 160.6 vs. 213.8 ± 181.3 cm²;p = 0.367). There was a reduction in wound breakdown (6.5% vs. 0.8%) and recurrence (2.9% vs. 0.6%)(p < 0.05).

Conclusion

Following the introduction of BTA, utilization of CST decreased and was accompanied by a reduction in wound morbidity.

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术前引入肉毒杆菌毒素A后，随着时间的推移，成分分离技术在复杂腹壁重建中的应用减少

成分分离技术（CST）有助于前筋膜闭合，但可能增加伤口发病率和改变腹壁解剖结构。术前使用肉毒毒素A （BTA）放松斜肌，可能降低CST。本研究评估了采用BTA后CST利用的趋势。方法回顾性分析开放性AWR患者（2016-2024）的前瞻性维护数据库。主要结局是CST的使用比例随时间的变化；二级分析比较了早期（2016-2017）和晚期（2023-2024）队列。结果1484例患者（平均年龄58.8±12.3岁，BMI 31.0±5.8 kg/m2，缺损面积211.5±165.6 cm2）中，99.5%的患者筋膜愈合。CST从48.0%下降到19.9% （OR: 0.88,95% CI: 0.813,0.946;p < 0.001）。BTA增加（2.9% ~ 11.0%），但年度变化不显著（OR: 0.98,95% CI: 0.898,1.071;p = 0.670）。在早期和晚期队列中（n = 384比356），缺陷大小相似（219.1±160.6比213.8±181.3 cm2;p = 0.367）。创面破裂（6.5% vs. 0.8%）和复发率（2.9% vs. 0.6%）均有降低（p < 0.05）。结论引入BTA后，CST的使用率下降，伤口发病率降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.