title: Clinical application of an acellular biologic scaffold for surgical repair of a large, traumatic quadriceps femoris muscle defect.
abstract: 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.
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam, Houston, TX 78234, USA.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Mase
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wenke
authors.forename: David G
authors.initials: DG
authors.lastname: Baer
authors.forename: Johnny
authors.initials: J
authors.lastname: Owens
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Badylak
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walters
mesh_terms: 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
chemical_list: D001672:Biocompatible Materials