title: Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management.
abstract: OBJECTIVE
  Abdominal wall hernia secondary to open abdomen management represents a surgical challenge. The hernia worsens due to lateral muscle retraction. Our objective was to evaluate if Botulinum Toxin Type A (BTA) application in lateral abdominal wall muscles modifies its thickness and length.
  
  
  METHODS
  A clinical trial of male trauma patients with hernia secondary to open abdomen management was performed from January 2009 to July 2011. Thickness and length of lateral abdominal muscles were measured by a basal Computed Tomography and 1 month after BTA application. A dosage of 250 units of BTA was applied at five points at each side between the external and internal oblique muscles under ultrasonographic guidance. Statistical analysis for differences between basal and after BTA application measures was performed by a paired Student's t test (significance: p < 0.05).
  
  
  RESULTS
  Seventeen male patients with a mean age of 35 years were included. There were muscle measure modifications in all the patients. Left muscle thickness: mean reduction of 1 ± 0.55 cm (p < 0.001). Right muscle thickness: mean reduction of 1.00 ± 0.49 cm (p < 0.001). Left muscle length: mean increase of 2.44 ± 1.22 cm (p < 0.001). Right muscle length: mean increase of 2.59 ± 1.38 cm (p < 0.001). No complications secondary to BTA or recurrences at mean follow-up of 49 months were observed.
  
  
  CONCLUSIONS
  BTA application in lateral abdominal muscles decreases its thickness and increases its length in abdominal wall hernia patients secondary to open abdomen management.
authors.affiliation: Department of Trauma Surgery, Antiguo Hospital Civil de Guadalajara "Fray Antonio Alcalde", Calle Hospital 278, Col. El Retiro, 44280, Guadalajara, Jalisco, Mexico, tomasibarra2005@yahoo.com.mx.
authors.forename: T R
authors.initials: TR
authors.lastname: Ibarra-Hurtado
authors.forename: C M
authors.initials: CM
authors.lastname: Nuño-Guzmán
authors.forename: A G
authors.initials: AG
authors.lastname: Miranda-Díaz
authors.forename: R
authors.initials: R
authors.lastname: Troyo-Sanromán
authors.forename: R
authors.initials: R
authors.lastname: Navarro-Ibarra
authors.forename: L
authors.initials: L
authors.lastname: Bravo-Cuéllar
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery; D000009:Abdominal Muscles / Q000187:drug effects* / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006555:Hernia, Ventral / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007273:Injections, Intramuscular; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A