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Botulinum Toxin A for Improving Lack of Ankle Dorsiflexion Range of Motion After Major Burns—A Retrospective Chart Review

  • Kevin Vu
    Affiliations
    Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center Dallas, Dallas, TX
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  • Karen Kowalske
    Correspondence
    Corresponding author Karen Kowalske, MD, Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center Dallas, 5223 Harry Hines Blvd, Dallas, TX 75390-9055.
    Affiliations
    Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center Dallas, Dallas, TX
    Search for articles by this author
Published:August 19, 2019DOI:https://doi.org/10.1016/j.apmr.2019.07.006

      Abstract

      Objective

      To review the effectiveness of botulinum toxin A (BTX-A) for treating the loss of maximum ankle dorsiflexion range of motion after burn injury.

      Design

      Retrospective chart review.

      Setting

      Large urban burn center.

      Participants

      Patients (3-51 y) with major burn injury and loss of ankle dorsiflexion range while hospitalized (N=5).

      Intervention

      BTX-A treatment in addition to standard care.

      Main Outcome Measures

      Maximum ankle dorsiflexion range of motion at time of treatment, 1 month and 3 months posttreatment.

      Results

      Patients’ total burn area ranged from 18% to 95%, and time from injury to BTX-A injection (80-125 units) was 19-93 days. Ankle range at the time of injection was −10 to −50 degrees, and all patients had improved ankle range at 1 month postinjection (−30 to +10 degrees). At 3 months postinjection, 3 participants had neutral ranges of motion that were relatively improved compared to preinjection ranges. Patients with additional complications or severe injury showed regression toward preinjection maximum ankle dorsiflexion range of motion.

      Conclusion

      This retrospective study examines BTX-A as a potential tool for treating ankle plantar flexion contractures post major burn injury after failed conservative treatment. Initial review shows some patients may benefit from these injections, but more systematically designed studies are required to assess effectiveness. If effective, further investigation will be needed to validate and standardize treatment protocols, establish dosing, and assess long-term effectiveness in those with burn injury or severe complications.

      Keywords

      List of abbreviations:

      BTX-A (botulinum toxin A), EHL (extensor hallucis longus), ROM (range of motion), TBSA (total body surface area)
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      References

        • Cuttle L.
        • Kempf M.
        • Phillips G.E.
        • et al.
        A porcine deep dermal partial thickness burn model with hypertrophic scarring.
        Burns. 2006; 32: 806-820
        • Jarrett M.
        • McMahon M.
        • Stiller K.
        Physical outcomes of patients with burn injuries—a 12 month follow-up.
        J Burn Care Res. 2008; 29: 975-984
        • Trudel G.
        • Uhthoff H.K.
        Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee.
        Arch Phys Med Rehabil. 2000; 81: 6-13
        • Trudel G.
        • Laneuville O.
        • Coletta E.
        • Goudreau L.
        • Uhthoff H.K.
        Quantitative and temporal differential recovery of articular and muscular limitations of knee joint contractures; results in a rat model.
        J Appl Physiol. 2014; 117: 730-737
        • Oki S.
        • Ono T.
        • Shimizu M.E.
        • Otsuka A.
        • Kanai S.
        • Shimatani K.
        Contribution of articular and muscular structures to the limitation of range of motion after joint immobility: an experimental study on the rat ankle.
        Biomed Res. 2008; 19: 78-81
        • Kowalske K.
        • Holavanahalli R.
        • Helm P.
        Neuropathy after burn injury.
        J Burn Care Rehabil. 2001; 22 (discussion 352): 353-357
        • Goverman J.
        • Mathews K.
        • Goldstein R.
        • et al.
        Adult contractures in burn injury: a Burn Model System National Database Study.
        J Burn Care Res. 2016; 38: e328-e336
        • Leblebici B.
        • Adam M.
        • Bagis S.
        • et al.
        Quality of life after burn injury: the impact of joint contracture.
        J Burn Care Res. 2006; 27: 864-868
        • Serghiou M.A.
        • Niszczak J.
        • Parry I.
        • Richard R.
        Clinical practice recommendations for positioning of the burn patient.
        Burns. 2016; 42: 267-275
        • Ricks N.R.
        • Meagher Jr., D.P.
        The benefits of plaster casting for lower-extremity burns after grafting in children.
        J Burn Care Rehabil. 1992; 13: 465-468
        • Bennett G.B.
        • Helm P.
        • Purdue G.F.
        • Hunt J.L.
        Serial casting: a method for treating burn contractures.
        J Burn Care Rehabil. 1989; 10: 543-545
        • Puri V.
        • Khare N.
        • Venkateshwaran N.
        • et al.
        Serial splintage: preoperative treatment of upper limb contracture.
        Burns. 2013; 39: 1096-1100
        • Godleski M.
        • Oeffling A.
        • Bruflat A.K.
        • Craig E.
        • Weitzenkamp D.
        • Lindberg G.
        Treating burn-associated joint contracture: results of an inpatient rehabilitation stretching protocol.
        J Burn Care Res. 2013; 34: 420-426
        • Saghieh S.
        • El Bitar Y.
        • Berjawi G.
        • Harfouche B.
        • Atiyeh B.
        Distraction histogenesis in ankle burn deformities.
        J Burn Care Res. 2011; 32: 160-165
        • Carmichael K.D.
        • Maxwell S.C.
        • Calhoun J.H.
        Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation.
        J Pediatr Orthop. 2005; 25: 523-528
        • Calhoun J.H.
        • Evans E.B.
        • Herndon D.N.
        Techniques for the management of burn contractures with the Ilizarov Fixator.
        Clin Orthop Relat Res. 1992; 280: 117-124
        • Satila H.
        • Pietikainen T.
        • Iisalo T.
        • et al.
        Botulinum toxin type A injections into the calf muscles for treatment of spastic equinus in cerebral palsy: a randomized trial comparing single and multiple injection sites.
        Am J Phys Med Rehabil. 2008; 87: 386-394
        • Elovic E.P.
        • Munin M.C.
        • Kanovsky P.
        • Hanschmann A.
        • Hiersemenzel R.
        • Marciniak C.
        Randomized, placebo-controlled trial of incobotulinumtoxina for upper-limb post-stroke spasticity.
        Muscle Nerve. 2016; 53: 415-421
        • Lui J.
        • Sarai M.
        • Mills P.B.
        Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review.
        Spinal Cord. 2015; 53: 252-264
        • Seyler T.M.
        • Jinnah R.H.
        • Koman L.A.
        • et al.
        Botulinum toxin type A injections for the management of flexion contractures following total knee arthroplasty.
        J Surg Orthop Adv. 2008; 17: 231-238
        • Daffunchio C.
        • Caviglia H.
        • Nassif J.
        • Morettil N.
        • Galatro G.
        Knee flexion contracture treated with botulinum toxin type A in patients with haemophilia (PWH).
        Haemophilia. 2016; 22: 134-141
        • Kay R.M.
        • Rethlefsen S.A.
        • Fern-Buneo A.
        • Wren T.A.
        • Skaggs D.L.
        Botulinum toxin as an adjunct to serial casting treatment in children with cerebral palsy.
        J Bone Joint Surg Am. 2004; 86-A: 2377-2384
        • Arad E.
        • Stephens D.
        • Curtis C.G.
        • Clarke H.M.
        Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy.
        Plast Reconstr Surg. 2013; 131: 1307-1315
        • Akhtar N.
        • Brooks P.
        The use of botulinum toxin in the management of burns itching: preliminary results.
        Burns. 2012; 38: 1119-1123
        • Flett P.
        • Stern L.
        • Waddy H.
        • Connell T.
        • Seeger J.
        • Gibson S.
        Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy.
        J Paediatr Child Health. 1999; 35: 71-77
        • Pavone V.
        • Testa G.
        • Restivo D.A.
        • et al.
        Botulinum toxin treatment for limb spasticity in childhood cerebral palsy.
        Front Pharmacol. 2016; 7: 29