Botox deployed to repair a hernia

Botox may be most famous for helping celebrities maintain an illusion of youthfulness, but the drug is increasingly used by doctors far from the cosmetic realm – including MUSC Health trauma surgeon Evert Eriksson and physiatrist Emily Darr, who used the toxin to prepare a patient for an otherwise unfeasible hernia repair.

“When he came up with the Botox, I thought ohhhh-kayyy,” recalled patient Jacqueline Goff.

But, she added, she trusts Eriksson with her life.

That’s because Eriksson, Trauma medical director in the Division of General and Acute Care Surgery, was on call the night of June 22, 2018. That’s the night that a wrong-way driver crashed into a car that Goff and her best friend, then-Congressional candidate Katie Arrington, were in. The pair suffered severe traumatic injuries. The other driver died at the scene.

“Jackie’s injury is considerably more complex than Katie’s. Katie’s is a more typical car wreck injury that we see. Her injuries are something we deal with every day. Jackie’s injury is a whole different ball game and much harder to get a good outcome from,” he said.

The seatbelt had sliced through Goff’s abdomen like a taut nylon cord through wet clay. The injury required multiple surgeries during Goff’s initial hospital stay just for basic repairs to internal organs. While Arrington went home after two weeks, Goff remained in the hospital for 62 days before transferring out for rehab.

“This is the worst seatbelt injury I’ve ever seen,” Eriksson said. “Among all the attending doctors as well, no one’s seen this bad of an injury from a seatbelt.” Goff needed an entire reconstruction of the left side of her abdominal wall after all the muscle was pulled off of the pelvis bones.

Goff left the hospital with a bridging biologic mesh acting as a stand-in for her abdominal wall – the muscles that normally “keep all her insides inside,” according to Eriksson. Because of the injury, her right and left abdominal muscles no longer met in the middle. Even with the mesh and the stiffest Spanx she could find, she still had a visible hernia.

Finally, in the summer of 2019, it was time to plan the hernia repair surgery. Eriksson knew he wouldn’t be able to pull the muscles back into place manually.But he’d heard about cases where Botox was used to relax muscles enough that they could be pulled and stretched back into position. He didn’t know of anyone at MUSC Health who had used such a technique, so he spoke to hernia experts around the country and came to the conclusion that Botox was Goff’s best chance for recovery. Without it, he said, she’d likely have a bridging repair – a surgical fix that could lead to ongoing issues with mobility and strength and had a high chance of hernia recurrence.

Eriksson then reached out to Darr, a physical medicine and rehabilitation doctor who uses Botox in her practice. Darr, relying on her experience and the latest research, calculated that 300 units would be an appropriate dose for Goff. She used ultrasound to guide her with precision as she injected the neurotoxin into the muscle.

Eriksson and Goff returned to the operating room in August for the final hernia repair. With Goff’s muscles now relaxed from the Botox, Eriksson could pull them from their shortened and thickened state – rather like Silly Putty, he explained – to a longer, thinner position where they met in the middle. He sewed the muscles together, giving her a functional abdominal wall. Once the Botox wore off, he explained, the muscles began to adapt to their new stretched position.

She remains amazed that she and Arrington survived the crash. And she thinks constantly about Eriksson and his team. “When I wake up in the morning, he’s in my prayers,” she said.