{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T01:22:02Z","timestamp":1780363322515,"version":"3.54.1"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T00:00:00Z","timestamp":1609113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Complex ventral hernias following laparotomy present a unique challenge in that repair is hindered by the lateral tension of the abdominal wall. A novel approach to overcome this is the \u201cchemical component separation\u201d technique. Here, botulinum toxin A (BTA) is instilled into the muscles of the abdominal wall. This induces flaccid paralysis and effectively reduces tension in the wall, allowing the muscles to be successfully joined in the midline during surgery. We describe a method where a large incisional hernia was repaired using this technique and review the variations in methodology. Case report: A woman in her mid-40s developed a ventral hernia in the setting of a previous laparotomy for a small bowel perforation. Computed tomography (CT) of the abdomen demonstrated an 85 (Width) \u00d7 95 mm (Length) ventral hernia containing loops of the bowel. Pre-operative botulinum toxin A administration was arranged at the local interventional radiology department. A total of 100 units of BTA were instilled at four sites into the muscular layers of the abdominal wall under CT-fluoroscopic guidance. She underwent an open incisional hernia repair 4 weeks later, where the contents were reduced and the abdominal wall layers were successfully joined in the midline. There was no clinical evidence of hernia recurrence at 3-months follow-up. Conclusion: Low-dose BTA effectively facilitates the surgical management of large ventral incisional hernias. There is, however, significant variation in the dosage, concentration and anatomical landmarks in which BTA is administered as described in the literature. Further studies are needed to assess and optimise these variables.<\/jats:p>","DOI":"10.3390\/medicina57010014","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T10:33:56Z","timestamp":1609151636000},"page":"14","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Low-Dose Pre-Operative Botulinum Toxin A Effectively Facilitates Complex Ventral Hernia Repair: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1093-4352","authenticated-orcid":false,"given":"Ali P.","family":"Mourad","sequence":"first","affiliation":[{"name":"Department of Surgery, The Wollongong Hospital, New South Wales 2500, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5753-8344","authenticated-orcid":false,"given":"Marie Shella","family":"De Robles","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Wollongong Hospital, New South Wales 2500, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9443-8326","authenticated-orcid":false,"given":"Robert D.","family":"Winn","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Wollongong Hospital, New South Wales 2500, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.amjsurg.2012.01.012","article-title":"Impact of incisional hernia on health-related quality of life and body image: A prospective cohort study","volume":"204","author":"Ramshorst","year":"2012","journal-title":"Am. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S1072-7515(02)01478-3","article-title":"\"Components separation technique\" for the repair of large abdominal wall hernias","volume":"196","author":"Vries","year":"2003","journal-title":"J. Am. Coll. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.17352\/2455-2283.000014","article-title":"Complex Incisional Hernias","volume":"2","author":"Scheuerlein","year":"2016","journal-title":"Arch Clin Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10029-013-1168-6","article-title":"Criteria for definition of a complex abdominal wall hernia. Hernia","volume":"18","author":"Slater","year":"2014","journal-title":"J. Hernias Abdom. Wall Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/00006534-199009000-00023","article-title":"\u201cComponents Separation\u201d Method for Closure of Abdominal-Wall Defects: An Anatomic and Clinical Study","volume":"86","author":"Ramirez","year":"1990","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1055\/s-0032-1302462","article-title":"Component separations","volume":"26","author":"Heller","year":"2012","journal-title":"Semin Plast Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1053\/sder.2001.25136","article-title":"Other noncosmetic uses of BOTOX","volume":"20","author":"Verheyden","year":"2001","journal-title":"Semin. Cutan. Med. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.mib.2012.05.012","article-title":"Clinical applications of botulinum toxin","volume":"15","author":"Dressler","year":"2012","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_9","first-page":"134","article-title":"Preoperative conditioning and surgical strategies for treatment of complex abdominal wall hernias","volume":"91","year":"2020","journal-title":"Chirurg"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1007\/s00268-009-0203-3","article-title":"Use of botulinum toxin type a before abdominal wall hernia reconstruction","volume":"33","author":"Ibarra","year":"2009","journal-title":"World J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s10029-014-1280-2","article-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. Hernia","volume":"18","author":"Ibarra","year":"2014","journal-title":"J. Hernias Abdom. Wall Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/ans.13258","article-title":"Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair","volume":"86","author":"Farooque","year":"2016","journal-title":"ANZ J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s00464-016-5030-7","article-title":"Preoperative chemical component relaxation using Botulinum toxin A: Enabling laparoscopic repair of complex ventral hernia","volume":"31","author":"Elstner","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s00464-017-5750-3","article-title":"Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia","volume":"32","author":"Rodriguez","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_15","first-page":"169","article-title":"The component separation index: A standardized biometric identity in abdominal wall reconstruction","volume":"12","author":"Christy","year":"2012","journal-title":"Eplasty"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jss.2015.06.033","article-title":"Computed tomographic measurements predict component separation in ventral hernia repair","volume":"199","author":"Blair","year":"2015","journal-title":"J. Surg. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2147\/CCID.S202919","article-title":"Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect","volume":"12","author":"Satriyasa","year":"2019","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1185\/03007990903028203","article-title":"Dose equivalence of two commercial preparations of botulinum neurotoxin type A: Time for a reassessment?","volume":"25","author":"Wohlfarth","year":"2009","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1213\/XAA.0000000000001033","article-title":"Preoperative Ultrasound-Guided Botulinum Toxin A Injection Facilitates Closure of a Complex Abdominal Wall Hernia: A Case Report","volume":"13","author":"Tamboli","year":"2019","journal-title":"A&A Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1001\/archderm.140.11.1351","article-title":"Effect of volume and concentration on the diffusion of botulinum exotoxin A","volume":"140","author":"Hsu","year":"2004","journal-title":"Arch. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1067\/j.cpradiol.2007.08.001","article-title":"Ultrasound-guided therapeutic procedures in the musculoskeletal system","volume":"37","author":"Cura","year":"2008","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3389\/fsurg.2020.00003","article-title":"Preoperative Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Hernias\u2014Our First 100 Cases","volume":"7","author":"Bueno","year":"2020","journal-title":"Front. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2830","DOI":"10.1007\/s00268-013-2211-6","article-title":"Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs","volume":"37","author":"Zendejas","year":"2013","journal-title":"World J. 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