Botulinum toxin type A in the healing of a chronic buttock ulcer in a patient with spastic paraplegia after spinal cord injury.
BACKGROUND
Pressure sores are a significant secondary complication in spinal cord injured patients. A new indication for botulinum toxin type A is described here, in treatment of recurrent muscular spasms that had hampered the healing of a chronic buttock ulcer in a subject with severe spastic paraplegia.


METHODS
A 27-year-old man with spastic paraplegia following traumatic spinal cord lesion at the thoracic level had developed recurrent severe muscular spasms, particularly involving the buttock region, with an Ashworth scale score of 3-4 and a Spasm Frequency Scale of grade 4. The patient had a pressure ulcer in the left gluteal region (grade IV according to the European Pressure Ulcer Advisory Panel (EPUAP). Several treatments were administered without success, and all efforts at healing the ulcer by topical medication were hampered by recurrent spasms involving the buttock muscles and ulcer region. The left gluteus maximus muscle was treated with 2 infiltrations of 660 IU botulinum toxin type A. The use of botulinum toxin type A allowed better care of the pressure ulcer, which had healed by 6 months after the initial infiltration.


CONCLUSIONS
The use of botulinum toxin type A may be an important adjunctive therapy for treatment of pathological conditions involving recalcitrant involuntary muscle contraction.
Intiso
Domenico
D
Department of Neuro-Rehabilitation, Scientific Institute Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy. d.intiso@operapadrepio.it
Basciani
Mario
M
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002081:Buttocks; D002908:Chronic Disease; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010264:Paraplegia / Q000150:complications*; D003668:Pressure Ulcer / Q000188:drug therapy*; D012008:Recurrence; D013119:Spinal Cord Injuries / Q000150:complications*; D014945:Wound Healing / Q000187:drug effects
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A