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.

Trends in Mesenchymal Stem Cells' Applications for Skeletal Muscle Repair and Regeneration

“…Acquired muscle affections are seemingly more common in active humans, greatly associated to sports practice, but also quite frequent in other traumatic sceneries, such as road or workrelated accidents or war injuries [8][9][10][11]. Muscle damage can result from ischemia and denervation, to contusion, sprain damage, laceration, avulsion, and other severe tissue losses.…”

Decellularized extracellular matrices for tissue engineering applications

“…In rodent models of traumatic volumetric muscle loss (VML) injuries, DECM scaffolds such as rodent muscle-derived ECM [8,44], commercially available SIS-ECM [45] and porcine UBM matrix (MatriStem TM , ACell , Inc.) [13,46], did not appreciably regenerate muscle fiber in vivo and remodeled into a fibrotic scar. In a clinical case study by Mase et al, a military service member with traumatic skeletal muscle injury was treated with a porcine SIS scaffold into the defect site that resulted in functional improvement at 16 weeks without significant muscle fiber regeneration [47]. In a recent study by Sicari et al, porcine UBM scaffold (MatriStem TM , ACell , Inc.) implantation in patients with VML resulted in improved stem cell mobilization and force production with severely limited muscle regeneration [2].…”

Biological and bactericidal properties of Ag-doped bioactive glass in a natural extracellular matrix hydrogel with potential application in dentistry

“…ECM hydrogels have been successfully isolated and used in several regenerative medicine applications Valentin et al, 2010;Singelyn et al, 2012). ECMs have been shown to promote tissue healing and regeneration in a number of anatomic locations, including skeletal muscle (Marelli et al, 2010;Mase et al, 2010), oesophagus (Nieponice et al, 2009) and urinary bladder (Boruch et al, 2010). However, it is not clear if they can inhibit pathogenic bacterial growth and prevent secondary caries formation (Ljungh et al, 1996).…”