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Mechanical Stimulation Improves Recovery from Volumetric Muscle Loss Injury in Swine
Eddy Rios, B.S.; Daniah ALNafisee, MD; Hiroshi Fujimaki, MD, Ph.D; Mitchell Kennedy, B.S.; Ariana Fantakis Ettorre, B.S; Neha Kamireddi, B.S.; Samantha Kroon, B.S.; Monica Royo, B.S.; Victoria Pajak, B.S.; Nicole Ayres, B.S.; Bilal Chaudhry, MD; Maria Bejar, MD; Giorgio Giatsidis, MD, Ph.D.
RESICE Lab, UMass Chan School of Medicine Dept of Surgery, Division of Plastics
Background: Over 40,000 traumatic open fractures with volumetric muscle loss (VML) occur annually in the United States. Functional outcomes are poor, as ~20% muscle volume loss causes strength deficits of 30-90%. The gold standard in VML management, physical therapy, achieves partial functional recovery (17-58%). Our previous murine model of VML showed that mechanical stimulation (MS) of skeletal muscles improves recovery of maximal torque (MMT) (+26%), stimulates angiogenesis (+41%), and reduces fibrosis (-21%). We hypothesize that MS would have similar outcomes in a large animal VML model.?
Methods: Surgically induced left Peroneus Tertius muscle (PTM) injury in female (38-42 kg) Yucatan pigs served as the VML model. Injured animals received no treatment (n=6) or MS of the PTM (n=8). Outcomes included post-injury day (PID)35 recovery of pre-injury MMT, PID35 strength in newton-centimeters (ncm) per gram of PTM tissue, PID35 Masson stains for fibrosis, pedometer activity levels, fatigue index (FI), and weekly gait assessments.
Results: Compared to controls, treated animals showed significantly improved recovery of pre-injury MMT (32±25% vs 12±5%; p=0.0026), higher PTM strength per gram of muscle tissue (1.6±1.2 ncm/g vs 3.3±3.1 ncm/g; p=0.024) reduced fibrosis (16±12% vs 24±16%; p=0.048), insignificant improved activity level recovery (110±75% vs 75±77%; p=0.18), and no significant differences in FI nor gait recovery.
Conclusion: MS seems to promote strength recovery and reduce fibrosis after VML injury in a translational large animal model. These promising results should be confirmed in a larger cohort of animals, in anticipation of a pilot clinical trial.
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