Muscle Lacerations Research Articles

Comparing 3 Suture Techniques After Muscle Laceration Repair.

Background: Skeletal muscle lacerations are a relatively common injury. Compared with nonrepaired lacerations, surgically repaired muscle lacerations regenerate faster, develop less scar tissue, have a higher return to baseline strength, and have lower incidence of hematomas. Despite the benefits of repair, the optimal repair technique is still unknown. The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the optimal repair. Methods: Forty-two fusiform porcine muscle specimens were dissected and used for this study. Three suture techniques were used for comparative analysis: Figure-eight, Mason Allen, and Perimeter. Each muscle was transected and then repaired using one of the 3 techniques. Fourteen muscle-tendon specimens were prepared for each group and tested for tensile failure using a material testing system. Biomechanical properties, including peak failure point and stiffness, were compared for differences between the suture groups by 1-way analysis of variance. The average time per repair technique was also recorded. Results: The Perimeter technique showed a statistically significant higher peak failure point than the Mason Allen technique (P = .03). Both the Figure-eight (P = .047) and Perimeter techniques (P < .001) were significantly stiffer than the Mason Allen technique. The repair time was comparable across all 3 techniques. Conclusions: The Figure-eight and Perimeter repairs were found to be similar in peak failure point and stiffness, whereas the Mason Allen technique showed significantly lower stiffness and peak failure point. The Figure-eight was the quickest repair to perform. The Figure-eight technique may be strongly considered for muscle laceration repairs due to its simplicity and efficiency.

Metal accessories for children: when jewelry becomes a real risk of eye loss

This study involved a 10-year old female patient admitted to the Ophthalmic Emergency Department with domestic trauma caused by her metal jewelry hung to the conjunctiva and the eyelid. Ophthalmic examination was strictly normal with the exception of the foreign body remarkably visible to the naked eye. The ablation of the foreign body resulted in localized subconjunctival haemorrhage without palpebral lesions, lesions of the right lateral muscle, conjunctival or scleral lacerations. The patient underwent treatment with artificial tears and antibiotics with good evolution. Tetanus vaccination was updated. It is essential to pay attention to metal accessories for children but also to metal accessories for the entire population.

Ultrasonographic findings of shoulder teno-muscular structures in symptomatic and asymptomatic dogs.

B-mode sonographic evaluation of shoulder joint in dogs provides qualitative information concerning mainly tendon and muscles structures. Although the sonographic findings of tenomuscular lesions have been described previously, their frequency in symptomatic and asymptomatic patients has not been reported yet. Aim of the study was to describe and compare qualitative ultrasonographic findings of shoulder joint in clinically symptomatic and asymptomatic dogs and to speculate which lesions might be considered major responsible for lameness. Fifty-two dogs with shoulder lameness and 58 asymptomatic dogs (both with unremarkable radiographic findings) underwent ultrasonographic B-mode examination of the scapulohumeral joint. Lesions detected were recorded and statistically compared between groups. Significant differences between groups were observed for the number of ultrasonographic abnormalities detected and for fluid accumulation, biceps brachii tendon (BT) lesions and bone surface irregularities. Sonography was considered useful for the determination of lesions absence and for the detection of BT lesions, fluid accumulation, muscle lacerations and bone surface irregularities. The odds for symptomatic dogs were greater than for asymptomatic patients to ultrasonographically diagnose BT lesions, fluid accumulation and bone surface irregularities. Ultrasound has proven to be a useful tool in the evaluation of tenomusculoskeletal structures of shoulder in dogs with unremarkable radiographic findings. Our results suggest that ultrasonography is useful in the diagnosis of tendon abnormalities, fluid accumulation, muscle lacerations and bone surface irregularities as potential contributors to shoulder lameness in dogs.

Evaluating Sport Related Acute Skeletal Muscle Injuries Using Ultrasonography Assisted with 3-dimensional and Power Doppler Capabilities

Introduction: In football players' muscle injuries can be either strain injuries or contusions most commonly in the thigh, groin and calf muscles. The diagnosis is based on history, clinical examination, diagnostic soft tissue ultrasonography and Magnetic resonance imaging. The aim of the work: The study aimed to assess the value of ultrasonography assisted with 3dimensional (3D) and power Doppler capabilities in evaluating acute muscle injuries among football players. Materials and Methods: 40 football players suffered from acute muscle injuries were subjected to 2D , 3D and power Doppler ultrasonography and follow up. Results: 16 football players were diagnosed as grade 1 muscle strain, 10cases were diagnosed as a grade 11 muscle strain and 4 cases as grade 111 muscle strain, 6 cases with muscle contusions, 3 cases with muscle lacerations and 1 case with compartmental syndromes. Among them, 12 cases showed intra muscular hematomas of anechoic and mixed echo pattern. All cases were followed up after conservative and surgical management. Conclusion: Ultrasonography with its new modalities is highly valuable in evaluating football players with acute muscle injury and making an optimal decision of management.

Anatomic guide and sonography for surgical repair of leg muscle lacerations

BackgroundThere were over 110,000 leg laceration cases reported in the United States in 2011. Currently, muscle laceration is repaired by suturing epimysium to epimysium. Tendon-to-tendon repair is stronger, restores the muscle's resting length, and leads to a better functional recovery. Tendons retract into the muscle belly following laceration and surgeons have a difficult time finding them. Many surgeons are unfamiliar with leg muscle anatomy and the fact that the leg muscles have long intramuscular tendons that are not visible in situ. A surgical anatomic guide exists to help surgeons locate forearm tendons; no such guide exists for tendons in the leg. Materials and methodsThe leg tendon ends of 11 cadavers were dissected, measured, and recorded as percentages of leg length. High-frequency ultrasound was used to locate tendon ends in three additional cadavers. These locations were compared with the actual tendon ends located via dissection. ResultsThere was little variation in tendon end position within the cadaver group, between men and women or right and left legs. The data are presented as an anatomic guide to inform surgeons of the tendon ends' likely locations in the leg. ConclusionThe location of leg intramuscular tendon ends is predictable and the anatomic guide will help surgeons locate tendon ends and perform tendon-to-tendon repairs. Ultrasound is a potentially effective tool for detection of accurate location of repairable tendon ends in leg muscle lacerations.

Intramuscular nerve damage in lacerated skeletal muscles may direct the inflammatory cytokine response during recovery

The expression of inflammatory cytokines and growth factors in surgically repaired lacerated muscles over a 12-week recovery phase was investigated. We hypothesized that these expression levels are influenced by both neural and muscular damage within lacerated muscles. Microarrays were confirmed with reverse transcription-polymerase chain reaction assays and histology of biopsies at the lesion of three simulated lacerated muscle models in 130 adult rats. The lacerated medial gastrocnemius with the main intramuscular nerve branch either cut (DN), crushed but leaving an intact nerve sheath (RN); or preserved intact (PN) were compared. At 4 weeks, DN had a higher number of interleukins up-regulated. DN and RN also had a set of Bmp genes significantly expressed between 2 and 8 weeks (P ≤ 0.05). By 12 weeks, DN had a poorer and slower myogenic recovery and greater fibrosis formation correlating with an up-regulation of the Tgf-β gene family. DN also showed poorer re-innervation with higher mRNA expression levels of nerve growth factor (Ngf) and brain-derived neurotrophin growth factor (Bdnf) over RN and PN. This study demonstrates that the inflammatory response over 12 weeks in lacerated muscles may be directed by the type of intramuscular nerve damage, which can influence the recovery at the lesion site. Inflammatory-related genes associated to the type of intramuscular nerve damage include Gas-6, Artemin, Fgf10, Gdf8, Cntf, Lif, and Igf-2. qPCR also found up-regulation of Bdnf (1-week), neurotrophin-3 (2w), Lif (4w), and Ngf (4w, 8w) mRNA expressions in DN, making them possible candidates for therapeutic treatment to arrest the poor recovery in muscle lacerations (250).

Evaluation of a novel biomaterial for intrasubstance muscle laceration repair

The authors compare the effects of small intestinal submucosa (SIS) treatment to suture repair with respect to histologic and functional outcomes for complete muscle lacerations in a rabbit model. The authors hypothesized that SIS treatment of full-thickness muscle belly lacerations would significantly improve muscle function, strength, and regeneration compared to the current standard-of-care treatment. Muscle belly lacerations were created in the extensor digitorum longus (EDL) of both hind limbs of each rabbit. After randomization, lacerations were left unrepaired (n = 48) or repaired using a 4-0 Prolene modified Kessler stitch (n = 48). A flap of SIS graft was sutured into half (n = 24 each) of the repaired and unrepaired muscles forming four study groups. Suture repair with SIS augmentation of complete muscle lacerations resulted in healed tissue that most closely resembled normal muscle in terms of morphology and function when compared to current standard-of-care treatments. Active force production in this group reached 79% of uninjured controls 12 weeks after surgery. SIS may have important clinical advantages over suture repair alone and warrants further clinical study.

Pullout Forces of Sutures in Muscle Lacerations

The purpose of this study was to determine if complex suture techniques had higher pullout forces from muscle tissue than conventional stitching. Using transected cadaver muscle bellies, we performed repairs with various suture techniques and measured pullout forces. Epimyseal repair with conventional stitches (Kessler, figure eight, horizontal mattress) was inferior to complex stitches (modified Mason-Allen, perimeter). The combined complex stitches (perimeter and Mason-Allen) were strongest. Conventional stitches failed longitudinally through the muscle, whereas complex stitches failed transversely across the muscle. The complex combination of perimeter and Mason-Allen stitches had superior pullout resistance compared to conventional stitches.

Passive Biomechanical Properties of Sutured Mammalian Muscle Lacerations

Muscle trauma, such as laceration or transection, is a common occurrence, but repairing delicate tissue poses a clinical challenge. This is at least partially due to the lack of established muscle repair models. The purpose of this study was to compare the biomechanical properties of stitches in transected porcine and bovine muscle bellies. A biomechanical protocol was designed for measuring suture performance in muscle belly lacerations. Twenty simple stitches in porcine and 21 stitches in bovine specimens were tested. Individual stitches were placed in lacerated muscle bellies and tensioned on a biomechanical tester (model 8521S, Instron Corporation, Canton, MA). The mean maximum load for porcine (22.0 N) and bovine (23.9 N) stitches was not significantly different (p =. 48). The difference in mean strains at maximum load between porcine (9.7%) and bovine (8.0%) groups was statistically significant (p =. 004). Failure mechanisms were similar. One porcine stitch avulsed the muscle transversely, while 19 stitches tore out longitudinally. All 20 stitches tore out in bovine specimens. Sutured muscle was the weakest element in each test. The present study demonstrated that sutured muscles performed similarly for the two mammals regarding the parameters of maximum load and mechanism of failure. Regarding suturing of skeletal muscle lacerations, both mammalian models had similar biomechanical performance for maximum loads and failure mechanisms, while strain data differed. The stitch load magnitudes in this study approximate those required to successfully repair transected muscle. Knowledge introduced by this study fills a gap concerning muscle stitching relevant to clinical care.

MARKING AND RADIOTELEMETRY OF OREGON SPOTTED FROGS (RANA PRETIOSA)

We evaluated marking and radiotelemetry techniques of Oregon spotted frogs (Rana pretiosa) from October, 1996, through December, 2000, at Dempsey Creek, Thurston County, Washington. Knee tags (plastic, numerically-coded fingerling tags tied at the knee) and PIT tags (passive integrated transponders) were used to uniquely identify individuals. Transmitters weighing 1 to 1.8 g were attached to frogs using 5-mm wide nylon ribbon belts threaded through a tube at the anterior end of the transmitter. Four knee-tagged frogs exhibited skin and muscle lacerations and the technique was abandoned early in the study. PIT tags were expensive but proved to be convenient and reliable. The nylon ribbon transmitter attachment, applied 94 times, allowed us to monitor individual frogs for an average of 57 d but sometimes caused skin abrasions and had a 34% loss rate. We suggest ways to improve transmitter retention and prevent harm to frogs.

Improvement of muscle healing through enhancement of muscle regeneration and prevention of fibrosis.

Skeletal muscle is able to repair itself through regeneration. However, an injured muscle often does not fully recover its strength because complete muscle regeneration is hindered by the development of fibrosis. Biological approaches to improve muscle healing by enhancing muscle regeneration and reducing the formation of fibrosis are being investigated. Previously, we have determined that insulin-like growth factor-1 (IGF-1) can improve muscle regeneration in injured muscle. We also have investigated the use of an antifibrotic agent, decorin, to reduce muscle fibrosis following injury. The aim of this study was to combine these two therapeutic methods in an attempt to develop a new biological approach to promote efficient healing and recovery of strength after muscle injuries. Our findings indicate that further improvement in the healing of muscle lacerations is attained histologically by the combined administration of IGF-1 to enhance muscle regeneration and decorin to reduce the formation of fibrosis. This improvement was not associated with improved responses to physiological testing, at least at the time-points tested in this study.

Repair of severe muscle belly lacerations using a tendon graft

Fourteen patients with 58 severe forearm muscle belly lacerations had muscle repair using tendon grafts. At mean follow-up of 14 months, results of manual muscle testing (N = 58) were: grade 5, 42%, grade 4, 14%, grade 3, 9%, grade 2, 9%, grade 1, 12%, and grade 0, 15%. Mean grip strength of the injured extremity, in pounds per square inch, was 33.5 compared with 83.4 on the noninjured side. Tendon excursion and joint mobility were maintained, and there were no postoperative complications. Tendon grafting of severe muscle lacerations is an effective method to overcome extensive defects.