Clinical application of an acellular biologic scaffold for surgical repair of a large, traumatic quadriceps femoris muscle defect.
Many battlefield injuries involve penetrating soft tissue trauma often accompanied by skeletal muscle defects, known as volumetric muscle loss. This article presents the first known case of a surgical technique involving an innovative tissue engineering approach for the repair of a large volumetric muscle loss. A 19-year-old Marine presented with large volumentric muscle loss of the right thigh as a result of an explosion. The patient reported muscle weakness with right knee extension, secondary to volumentric muscle loss, primarily involving the vastus medialis muscle. This persisted 3 years postinjury, despite extensive physical therapy. With all existing management options exhausted, restoration of a portion of the lost vastus medialis muscle was attempted by surgical implantation of a multi-layered scaffold composed of extracellular matrix derived from porcine intestinal submucossa. The patient had no complications, was discharged home on postoperative day 5, and resumed physical therapy after 4 weeks. Four months postoperatively, the patient demonstrated marked gains in isokinetic performance. Computer tomography indicated new tissue at the implant site. This approach offers a treatment option to a heretofore untreatable injury and will allow us to improve future surgical treatments for volumetric muscle loss.
Mase
Vincent J
VJ
United States Army Institute of Surgical Research, Fort Sam, Houston, TX 78234, USA.
Hsu
Joseph R
JR
Wolf
Steven E
SE
Wenke
Joseph C
JC
Baer
David G
DG
Owens
Johnny
J
Badylak
Stephen F
SF
Walters
Thomas J
TJ
D001672:Biocompatible Materials; D001753:Blast Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008889:Military Personnel; D052097:Quadriceps Muscle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D020127:Recovery of Function; D023822:Tissue Engineering; D054457:Tissue Scaffolds; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000534:rehabilitation / Q000601:surgery*; D055815:Young Adult
D001672:Biocompatible Materials