The Effect of Botulinum Toxin A on Ischemia-Reperfusion Injury in a Rat Model

Introduction. While studies using various materials to overcome ischemia-reperfusion (IR) injury are becoming increasingly common, studies on the effects of botulinum toxin A (BoTA) on IR injury in musculocutaneous flaps are still limited. The purpose of this study was to examine our hypotheses that BoTA provide protection of musculocutaneous flap from ischemia-reperfusion injury. Method. Five days after pretreatment injection (BoTA versus normal saline), a right superior musculocutaneous flap (6 x 1.5 cm in size) was made. Ischemia was created by a tourniquet strictly wrapping the pedicle containing skin and muscle for 8 h. After ischemia, the tourniquet was cut, and the musculocutaneous flap was reperfused. Results. The overall survival percentage of flap after 8 h of pedicle clamping followed by reperfusion was 87.32 +/- 3.67% in the control group versus 95.64 +/- 3.25% in the BoTA group (p < 0.001). The BoTA group had higher expression of CD34, HIF-1 alpha, VEGF, and NF-kappa B comparing to control group in qRT-PCR analysis. Conclusions. In this study, we found that local BoTA preconditioning yielded significant protection against IR injury in a rat musculocutaneous flap model.