PDF(Pubmed)
Abstract：
Treatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in combat settings. To this end, polyvinyl alcohol (PVA) was used at concentrations of 5%, 7.5%, and 10% to generate provisional muscle void fillers (MVFs) of varying stiffness values (1.125 kPa, 3.700 kPa, and 7.699 kPa) to stabilize VML injuries as part of a two-stage approach. These were implanted into a rat model for a duration of 4 weeks, then explanted and either left untreated (control) or treated through minced muscle grafting (MMG). Additional benchmarks included acute MMG and unrepaired groups. At the MVF explant, the 7.5% PVA group exhibited superior neuromuscular function compared to the 5% and 10% PVA groups, the least fibrosis, and the largest median myofiber size among all groups at the 12-week endpoint. Despite the 7.5% PVA\'s superiority amongst the two-stage treatment groups, neuromuscular function was neither improved nor impaired relative to acute treatment benchmarks. This suggests that the future success of a two-stage VML treatment strategy will necessitate a more effective definitive intervention.
摘要：
体积肌肉损失（VML）的治疗由于其独特的病理生物学和在严重的肌肉骨骼损伤管理中的优先级较低而面临挑战。因此,需要多阶段VML治疗策略,以适应由于在战斗环境中的合并症管理或长期伤员护理而导致的延迟干预.为此,聚乙烯醇(PVA)以5%的浓度使用，7.5%,和10%以产生不同刚度值(1.125kPa，3.700kPa,和7.699kPa）以稳定VML损伤，作为两阶段方法的一部分。这些被植入大鼠模型持续4周，然后外植并不治疗（对照）或通过切碎的肌肉移植（MMG）进行治疗。其他基准包括急性MMG和未修复组。在MVF外植体，与5%和10%PVA组相比，7.5%PVA组表现出优越的神经肌肉功能，纤维化最少，在12周终点时，所有组的肌纤维中位数最大。尽管在两阶段治疗组中PVA的优势为7.5%，相对于急性治疗基准,神经肌肉功能既未改善也未受损.这表明两阶段VML治疗策略的未来成功将需要更有效的确定性干预。
