DOI: 10.1097/01.prs.0000256491.39590.56
,
,
PMID: 17415278
Issn Print: 0032-1052
Publication Date: 2007/04/15
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
The use of botulinum toxin in cosmetic surgery is well documented. We report on a case of botulinum toxin injection used successfully to treat lower limb traumatic ulceration in a patient with spastic lower limb dystonia.
Botulinum toxin acts at the neuromuscular junction, inhibiting acetylcholine release, directly blocking the sensory–motor reflex arc, and reducing spasticity. It has been used to treat spasticity in cervical dystonia1 and cerebral palsy2 by direct injection into the affected muscle belly. The indications for its use in such situations are pain and decreased movement associated with the muscle spasm. We describe the first case in which it has been used to treat skin ulceration by decreasing spasticity and repetitive clonic movement.
A 58-year-old, nonambulatory man with progressive cortical-cerebellar degeneration presented to our unit for management of bilateral chronic lower limb ulceration. There was no history of diabetes, venous insufficiency, or peripheral vascular disease, and the ulceration was thought to be secondary to his lower limb spasticity.
On examination, the patient had flexion deformities of both hips and knees with significantly increased tone in both legs and marked clonus. As a result of the effect of direct pressure and repeated trauma caused by the spastic movement of the heels of one leg against the shin and calf of the other, he had developed traumatic ulceration to both lower limbs (Fig. 1).
Management with oral anti spasmodics and bilateral adductor releases had proved unsuccessful. Botulinum toxin was injected into the adductor muscle bellies, first on the left and then on the right after a 2-week interval.
A week after the injections, a marked reduction in spasticity was noted in both legs. At 4 weeks, the ulcerated wounds showed signs of healing, with healthy granulation tissue. Eight weeks after the injections, the ulcers showed significant improvement, and they were fully healed at 16 weeks (Fig. 2).
The patient required a further injection in both adductor regions following return of some spasticity to the lower limbs, but the ulceration has not recurred. The treatment has also partially alleviated the patient’s lower limb flexion deformities, making nursing care easier.
