Abstract
Background
Surgical repair of muscle lacerations is the standard of care to restore function. Compared to non-surgically repaired lacerations, surgical repairs have been shown to heal faster and have higher strength return and lower incidence of hematomas. Multiple techniques have been reported to repair muscle lacerations. There are many factors to consider in choosing a technique for muscle belly repair including scar tissue formation, length of immobilization, strength of repair, and suture pullout. An ideal repair method has not yet been clearly identified; therefore, the purpose of this review is to evaluate the existing literature on various repair methods and the methods used to test them.
Methods
Using the PRISMA-ScR framework, a scoping review was performed to identify biomechanical studies that examined the strength and efficacy of muscle belly repair techniques. PubMed, Web of Science, and Scopus were searched to locate relevant studies.
Results
Nine original studies which met inclusion criteria were selected for final review. Six studies evaluated specific suture techniques, while the remaining three studies evaluated, inclusion of epimysium in the repair, repair of the epimysium versus perimysium, and porcine versus bovine skeletal muscle biomechanical properties. While the six studies evaluating suture techniques tested overlapping suture types, they varied in preload and peak load values and the type of suture used, yielding heterogenous data. The compiled data did not support one method being the optimal repair choice.
Conclusions
Existing literature evaluating the mechanics of muscle repair is limited by a lack of standardization. The included studies suggest that using sutures which incorporate the epimysium or using a combination of sutures that anchor the core of the muscle belly and encompass the perimeter may yield more robust repairs than other techniques. However, further research using comparable experimental conditions is necessary to identify an ideal muscle belly repair technique.
Level of evidence: Not gradable.
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Data Availability
The authors declare that the data supporting the findings of this review are included in the paper itself and in the articles referenced therein.
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Avril Stulginski, Medha Vallurupalli, Mikhail Pakvasa, Cathy J. Tang, Eric D. Wang, and Amber R. Leis declare no competing interests.
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Appendices
Appendix 1. PubMed search
Query | (muscle belly repair OR muscle laceration repair) AND technique AND (biomechanical testing OR tensile) NOT shoulder |
|---|---|
Details | ((((“muscle s”[All Fields] OR “muscles”[MeSH Terms] OR “muscles”[All Fields] OR “muscle”[All Fields]) AND (“bellies”[All Fields] OR “belly”[All Fields]) AND (“repairability”[All Fields] OR “repairable”[All Fields] OR “repaire”[All Fields] OR “repaired”[All Fields] OR “repairment”[All Fields] OR “wound healing”[MeSH Terms] OR (“wound”[All Fields] AND “healing”[All Fields]) OR “wound healing”[All Fields] OR “repair”[All Fields] OR “repairing”[All Fields] OR “repairs”[All Fields])) OR ((“muscle s”[All Fields] OR “muscles”[MeSH Terms] OR “muscles”[All Fields] OR “muscle”[All Fields]) AND (“lacerations”[MeSH Terms] OR “lacerations”[All Fields] OR “lacerate”[All Fields] OR “lacerated”[All Fields] OR “lacerating”[All Fields] OR “laceration”[All Fields]) AND (“repairability”[All Fields] OR “repairable”[All Fields] OR “repaire”[All Fields] OR “repaired”[All Fields] OR “repairment”[All Fields] OR “wound healing”[MeSH Terms] OR (“wound”[All Fields] AND “healing”[All Fields]) OR “wound healing”[All Fields] OR “repair”[All Fields] OR “repairing”[All Fields] OR “repairs”[All Fields]))) AND (“methods”[MeSH Terms] OR “methods”[All Fields] OR “technique”[All Fields] OR “methods”[MeSH Subheading] OR “techniques”[All Fields] OR “technique s”[All Fields]) AND (((“biomechanical phenomena”[MeSH Terms] OR (“biomechanical”[All Fields] AND “phenomena”[All Fields]) OR “biomechanical phenomena”[All Fields] OR “biomechanic”[All Fields] OR “biomechanics”[All Fields] OR “biomechanical”[All Fields] OR “biomechanically”[All Fields]) AND (“test s”[All Fields] OR “tested”[All Fields] OR “testing”[All Fields] OR “testings”[All Fields] OR “tests”[All Fields])) OR (“tensil”[All Fields] OR “tensile”[All Fields]))) NOT (“shoulder”[MeSH Terms] OR “shoulder”[All Fields] OR “shoulders”[All Fields] OR “shoulder s”[All Fields]) |
Translation | muscle: “muscle’s”[All Fields] OR “muscles”[MeSH Terms] OR “muscles”[All Fields] OR “muscle”[All Fields] belly: “bellies”[All Fields] OR “belly”[All Fields] repair: “repairability”[All Fields] OR “repairable”[All Fields] OR “repaire”[All Fields] OR “repaired”[All Fields] OR “repairment”[All Fields] OR “wound healing”[MeSH Terms] OR (“wound”[All Fields] AND “healing”[All Fields]) OR “wound healing”[All Fields] OR “repair”[All Fields] OR “repairing”[All Fields] OR “repairs”[All Fields] muscle: “muscle’s”[All Fields] OR “muscles”[MeSH Terms] OR “muscles”[All Fields] OR “muscle”[All Fields] laceration: “lacerations”[MeSH Terms] OR “lacerations”[All Fields] OR “lacerate”[All Fields] OR “lacerated”[All Fields] OR “lacerating”[All Fields] OR “laceration”[All Fields] repair: “repairability”[All Fields] OR “repairable”[All Fields] OR “repaire”[All Fields] OR “repaired”[All Fields] OR “repairment”[All Fields] OR “wound healing”[MeSH Terms] OR (“wound”[All Fields] AND “healing”[All Fields]) OR “wound healing”[All Fields] OR “repair”[All Fields] OR “repairing”[All Fields] OR “repairs”[All Fields] technique: “methods”[MeSH Terms] OR “methods”[All Fields] OR “technique”[All Fields] OR “methods”[Subheading] OR “techniques”[All Fields] OR “technique’s”[All Fields] biomechanical: “biomechanical phenomena”[MeSH Terms] OR (“biomechanical”[All Fields] AND “phenomena”[All Fields]) OR “biomechanical phenomena”[All Fields] OR “biomechanic”[All Fields] OR “biomechanics”[All Fields] OR “biomechanical”[All Fields] OR “biomechanically”[All Fields] testing: “test’s”[All Fields] OR “tested”[All Fields] OR “testing”[All Fields] OR “testings”[All Fields] OR “tests”[All Fields] tensile: “tensil”[All Fields] OR “tensile”[All Fields] shoulder: “shoulder”[MeSH Terms] OR “shoulder”[All Fields] OR “shoulders”[All Fields] OR “shoulder’s”[All Fields] |
Results | 25 |
Appendix 2. Summary outcomes of suture techniques
Study | Suture technique | Suture type | Preload | Loading | Maximum load | Mean strain | Stiffness | Displacement | Failure mode |
|---|---|---|---|---|---|---|---|---|---|
Kragh et al | Kessler | Size 2, braided polyester | 5–8 N | 25 mm/min | 35.1 N (SD 9.4) | 7.9 (SD 2.9) | - | - | Tear out (n = 5/5) |
He et al | Kessler | Size 5 and 6, polypropylene | 2 N | 60 mm/min | 15.5 N | - | 1 N/mm | - | - |
Chance et al | Kessler | Size 2, braided polyester | - | - | 16.18 N (SD 6.08) | - | - | - | Pullout (n = 12/13) Avulsion (n = 1/13) |
Castillo et al | Mason-Allen | Size 3, polyglactin | - | - | 45.39 N (SD 13.86) | - | 1.76 N/mm (SD 0.68) | 28.45 mm (SD 9.37) at maximum load | - |
Goyal et al | Mason-Allen | Size 1 and 2, Ethibond barbed PDS | 1 N | 60 mm/min | 12.73 N (SD 2.40) | - | - | 1.84 mm (SD 0.39) at 10N | - |
Chance et al | Mason-Allen | Size 2, braided polyester | - | - | 36.58 N (SD 11.28) | - | - | - | Avulsion (n = 13/13) |
Chance et al | Mattress | Size 2, braided polyester | - | - | 18.14 N (SD 5.10) | - | - | - | Avulsion (n = 31/31) |
He et al | Mattress | Size 5 and 6 polypropylene | 2 N | 60 mm/min | 4.4 N | - | 0.3 N/mm | - | - |
Castillo et al | Perimeter | Size 3, polyglactin | 3–5 N | 25 mm/min | 64.29 N (SD 19.30) | - | 3.24 N/mm (SD 0.73) | 64.29 mm (SD 19.30) at maximum load | - |
Chance et al | Perimeter | Size 2, braided polyester | - | - | 43.35 (SD 11.28) | - | - | - | Avulsion (n = 12/13) Pullout (n = 1/13) |
Kragh et al | MAP | Size 2, braided polyester | 5–8 N | 25 mm/min | 74 N (SD 11.3) | 12.2 (SD 3.7 | - | - | No failure |
Chance et al | MAP | Size 2, braided polyester | - | - | 62.76 N (SD 13.73) | - | - | - | Avulsion (n = 13/13) |
He et al | MAP | Size 5 and 6, polypropylene | 2 N | 60 mm/min | 13.2 N | - | 0.6 N/mm | - | - |
Castillo et al | Figure-of-8 | Size 3, polyglactin | 3–5 N | 25 mm/min | 54.18 N (SD 21.47) | - | 2.52 N/mm (SD 0.99) | 27.22 mm (SD 6.64) at maximum load | - |
Goyal et al | Figure-of-8 | Size 1 and 2, Ethibond barbed PDS | 1 N | 60 mm/min | 8.96 N (SD 4.24) | - | - | - | - |
Lionello et al | Figure-of-8 | Size 2, polyglactin | 10 N | 0.1 N/s | 59 N | - | 5 N/mm | - | - |
Chance et al | Figure-of-8 | Size 2, braided polyester | - | - | 17.36 N (SD 4.31) | - | - | - | Pullout (n = 13/13) |
Goyal et al | Modified Kessler | Size 1 and 2, Ethibond barbed PDS | 1 N | 60 mm/min | 7.71 N (SD 3.78) | - | - | - | - |
Lionello et al | Simple | Size 2, polyglactin | 10 N | 0.1 N/s | 61 N | - | - | - | - |
Goyal et al. (Barbed) | Custom/novel | Size 1 and 2 Ethibond barbed PDS | 1 N | 60 mm/min | 17.86 N (SD 2.26) | - | - | 1.57 mm (SD 0.39) at 10 N | - |
Goyal et al. (Ethibond) | Custom/novel | Size 1 and 2 Ethibond barbed PDS | 1 N | 60 mm/min | 13.16 N (SD 1.57) | - | - | 3.55 mm (SD 0.78) at 10 N | - |
Lionello et al | Custom/novel | Size 2, polyglactin | 10 N | 0.1 N/s | 85 N | - | 5.4 N/mm | - | - |
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Stulginski, A., Vallurupalli, M., Pakvasa, M. et al. Evaluating suturing methods for surgical repair of muscle belly lacerations: a scoping review of biomechanical studies. Eur J Plast Surg 47, 23 (2024). https://doi.org/10.1007/s00238-024-02161-w
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DOI: https://doi.org/10.1007/s00238-024-02161-w