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Unique use of botulinum toxin to decrease adductor tone and allow surgical excision of vulvar carcinoma
1Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. yguo@mdanderson.org
Summary
Botulinum toxin (BTX) injections and physical therapy successfully treated severe lower extremity spasticity in an elderly woman, enabling vulvar cancer surgery. This approach improved surgical access and patient outcomes.
Area of Science:
- Neurology
- Gynecologic Oncology
- Rehabilitation Medicine
Background:
- Vulvar carcinoma necessitates surgical resection.
- Severe lower extremity spasticity and contractures in Parkinson's disease can impede surgical positioning.
- An 86-year-old woman with Parkinson's disease presented with severe hip adductor spasticity, preventing vulvar access for cancer surgery.
Observation:
- Surgical access to the vulva was impossible due to the patient's severe contractures (knee separation of only 2 cm).
- The patient received botulinum toxin (BTX) injections to hip adductor and hamstring muscles.
- A regimen of intensive physical therapy and an adjustable abduction brace was initiated.
Findings:
- Following BTX injection and physical therapy, knee separation increased to 14 cm.
- The patient successfully underwent wide local excision of vulvar carcinoma with the abductor brace in place.
- The patient tolerated the procedure well and was discharged with ongoing physical therapy.
Implications:
- Botulinum toxin (BTX) offers a novel preoperative treatment to manage spasticity and improve surgical positioning.
- This case highlights a new indication for BTX in facilitating gynecologic oncology procedures in patients with severe contractures.
- Multidisciplinary management combining BTX, physical therapy, and bracing can overcome significant physical limitations for necessary surgical interventions.