Spinal cord injury patients with spasticity and pressure sores: Preliminary report on reconstruction with botulinum toxin treated muscle flaps

Background: Pressure sores are frequent complications in spinal cord injured patients (SCI). Unfortunately, spasticity may be associated to SCI, muscle spasms can be very intense in the post-operative period after pressure sore treatment and may cause wound dehiscence. Aim of the study is to investigate the efficacy of botulinum toxin (BTX) in preventing muscle flap spasms and complications in pressure sores treatment. Materials and methods: Prospective, observational, single center study on consecutive adult spinal cord injury patients affected by spasticity and pressure sore, with indication to surgical debridement and reconstruction with muscle flap. Muscle flap was prepared by injection of 100 units of BTX-A 10 days preoperatively. Collected data include patient and wound information, post-operative need for increased dose of anti-spasticity medications compared to the preoperative period, time to complete wound healing, follow up at 6 months. Results: Five adult patients with SCI, spasticity and trochanteric pressure sore were included in the study. All the patients were male, median age was 48. All the patients were paraplegic, and the etiology was spinal cord trauma. All sores were IV degree. Osteomyelitis was confirmed histologically in all the patients. None of the patients needed an increased dose of anti-spasticity medications, compared to the preoperative period. A complete healing of the wound was observed in all the cases 3 weeks after surgery. No recurrences were observed at a six months follow-up. Conclusion: BTX-A can be a useful method to prevent complications in SCI patients and pressures sores, when a muscle flap is planned.