Flexor Tendon Repair with Adjunctive Botulinum Toxin Administration: A Systematic Review

Chemical denervation with Botulinum toxin has been proposed as an augment therapy to flexor tendon repairs to decrease complications including adhesions and re-rupture. We compiled and analyzed the results and complications for chemical denervation with Botulinum toxin in augmentation of flexor tendon repairs. Reviewed studies were from 1990–2018 and contained a minimum 3-month follow-up. A total of 26 patients were included in this review. All patients were reported to have excellent or good outcomes by the Strickland or Kleinert criteria. Complications were present in 9.3% of fingers including one with a flexion contracture, one with postoperative swelling, one with bowstringing, one with residual hypesthesia and first web contracture. Only one patient required re-operation. There were no cases of re-rupture or adhesions reported. All complications were unrelated to the use of Botulinum toxin. We conclude that Botulinum toxin therapy is a safe and efficacious augmentation to flexor tendon repair. (Journal of Surgical Orthopaedic Advances 30(1):036–039, 2021)

Key words: flexor tendon repair, botulinum, chemprotection, bioprotection