RESUMEN
Background: The botulinum toxin is an extremely potent substance that impacts the nervous system. There has been a rise in cases of medical poisoning associated with it, particularly in the field of plastic and aesthetic procedures, in recent years. Case description: A 51-year-old woman underwent a facial wrinkle reduction procedure with an unauthorized injection of 100 U of botulinum toxin at an unlicensed medical facility six days prior to hospitalization. Over time, her toxicity symptoms intensified, impacting her respiratory muscles, and she did not receive antitoxin treatment. She was concurrently diagnosed with a COVID-19 infection during this period. Nonetheless, she experienced a full recovery 86 days after the injection. Conclusion: Currently, there is no effective antidote for botulism. Nevertheless, the timely administration of antitoxin can contribute to reducing the duration of the illness, alleviating symptoms, and preventing its recurrence. It is essential to recognize that individual responses may vary, and in this instance, the absence of antitoxin treatment did not significantly prolong the course of the disease. Accurate diagnosis of medical poisoning can be based on injection history and clinical symptoms. Early indications like fatigue and dry mouth warrant particular attention, emphasizing the importance of immediate medical intervention. To address emergencies, the Center for Disease Control (CDC) should maintain an accessible supply of antitoxin. Patients with severe poisoning should be hospitalized until their respiratory muscle strength is fully restored.
RESUMEN
OBJECTIVE: To observe the clinical effect of the concentrated suture fixation method on skin transplantation on deep burn wound or wound of cicatricial deformity after burn in the jaw and neck region. METHODS: One hundred and fourteen patients, hospitalized from April 2002 to December 2011, with deep burn or cicatricial deformity after burn in the jaw and neck region, were divided into packaging group and concentrated suture group according to the random number table. Each group had 57 patients including 48 cases with deep burn and 9 cases with cicatricial deformity. Traditional suture-package fixation method and concentrated suture fixation method were respectively used in packaging group and concentrated suture group to fix the autologous medium split-thickness skin in transplantation on wounds or scars. On post operation day (POD) 14, the skin microcirculatory perfusion flow of skin graft was measured, and the occurrence of ecchymoma, infection, and necrosis of skin in operative region were observed. The elasticity and contracture of grafted skin and scar hyperplasia on wound edge were observed 6 months after operation. Measurement data were processed with u test, while enumeration data with Fisher's exact test or Chi-square test. RESULTS: (1) On POD 14, the skin microcirculatory perfusion flow in concentrated suture group [(2.86 +/- 0.8) V] was significantly higher than that in packaging group [(2.33 +/- 0.15) V, u = 17.776, P < 0.05]. (2) Ecchymoma occurred in 4 patients of packaging group and 3 patients of concentrated suture group, but the difference between two groups was not statistically significant (chi 2 = 0.152, P > 0.05). (3) Infection in operative region was observed in 1 patient of packaging group, while no patient in concentrated suture group showed this symptom. The difference between two groups was not statistically significant (P > 0.05). (4) Grafted skin in 6 patients of packaging group showed foliated necrosis, which was not observed on those of patients in concentrated suture group. The difference between two groups was statistically significant (P < 0.05). (5) Centipede leg-like scar hyperplasia on wound edge occurred in 21 patients in packaging group and 6 patients in concentrated suture group, and the difference between two groups was statistically significant (chi 2 = 10.920, P < 0.05). (6) Poor elasticity of grafted skin was detected in 17 patients of packaging group and 4 patients of concentrated suture group, and the difference between two groups was statistically significant (chi 2 = 9.865, P < 0.05). (7) Obvious contracture of grafted skin was observed in 15 patients of packaging group and 4 patients of concentrated suture group, and the difference between two groups was statistically significant (chi 2 = 11.684, P < 0.05). CONCLUSIONS: Concentrated suture fixation method is suitable for application in transplantation of big sheet skin on wound in the jaw and neck region. It has high survival rate and is convenient for postoperative observation.