Soft Tissue Management of War Wounds to the Foot and Ankle

Baechler, Martin F.; Groth, Adam T.; Nesti, Leon J.; Martin, Barry

doi:10.1016/j.fcl.2009.10.006

Cited by 33 publications

(14 citation statements)

References 66 publications

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“…angiogenesis | tissue engineering | vascular biology | regenerative medicine F laps serve as important elements in reconstructive surgery, however, the availability of quality autologous muscle flaps, donor site morbidity, length of procedures, and cosmetic concerns present significant limiting factors (1)(2)(3)(4)(5)(6). Tissue survival is dependent on oxygen supply, which is limited to a diffusion distance of up to 300 μm from a supplying blood vessel (7,8).…”

Section: Improved Vascular Organization Enhances Functional Integratimentioning

confidence: 99%

Improved vascular organization enhances functional integration of engineered skeletal muscle grafts

Koffler

Kaufman‐Francis²,

Shandalov³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

186

184

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Severe traumatic events such as burns, and cancer therapy, often involve a significant loss of tissue, requiring surgical reconstruction by means of autologous muscle flaps. The scant availability of quality vascularized flaps and donor site morbidity often limit their use. Engineered vascularized grafts provide an alternative for this need. This work describes a first-time analysis, of the degree of in vitro vascularization and tissue organization, required to enhance the pace and efficacy of vascularized muscle graft integration in vivo. While one-day in vitro was sufficient for graft integration, a three-week culturing period, yielding semiorganized vessel structures and muscle fibers, significantly improved grafting efficacy. Implanted vessel networks were gradually replaced by host vessels, coupled with enhanced perfusion and capillary density. Upregulation of key graft angiogenic factors suggest its active role in promoting the angiogenic response. Transition from satellite cells to mature fibers was indicated by increased gene expression, increased capillary to fiber ratio, and similar morphology to normal muscle. We suggest a “relay” approach in which extended in vitro incubation, enabling the formation of a more structured vascular bed, allows for graft-host angiogenic collaboration that promotes anastomosis and vascular integration. The enhanced angiogenic response supports enhanced muscle regeneration, maturation, and integration.

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Section: Improved Vascular Organization Enhances Functional Integratimentioning

confidence: 99%

Improved vascular organization enhances functional integration of engineered skeletal muscle grafts

Koffler

Kaufman‐Francis²,

Shandalov³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

186

184

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show abstract

“…During the eight months of our practice, orthopaedic activities represented 73.83 % of all surgical procedures performed on soldiers. In level 3 hospitals, orthopaedic surgery is the most frequent type, representing between 40 and 77 % of surgical activities [6][7][8]. The use of military protective equipment, such as helmets, goggles and bulletproof vest in theatres of war increased extremity injuries (60 %) and significantly reduced craniofacial and chest injuries, which are most often fatal [4,9].…”

Section: Discussionmentioning

confidence: 99%

Extremity injuries in soldiers during the conflict in Mali: experience of Togo Level two Hospital

Akpoto

Abalo

Adam

et al. 2015

International Orthopaedics (SICOT)

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“…[1][2][3][4][5] However, debilitation remains a problem when donor muscle tissue is unavailable, and the defect is not completely repaired. 1,6 Studies in tissue engineering have devised techniques that utilize in vitro-cultured muscle cells to create muscle tissue for functional restoration in vivo.…”

Section: Introductionmentioning

confidence: 99%

Functional Recovery of Completely Denervated Muscle: Implications for Innervation of Tissue-Engineered Muscle

Kang

Olson

Atala

et al. 2012

Tissue Engineering Part A

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Tissue-engineered muscle has been proposed as a solution to repair volumetric muscle defects and to restore muscle function. To achieve functional recovery, engineered muscle tissue requires integration of the host nerve. In this study, we investigated whether denervated muscle, which is analogous to tissue-engineered muscle tissue, can be reinnervated and can recover muscle function using an in vivo model of denervation followed by neurotization. The outcomes of this investigation may provide insights on the ability of tissue-engineered muscle to integrate with the host nerve and acquire normal muscle function. Eighty Lewis rats were classified into three groups: a normal control group (n = 16); a denervated group in which sciatic innervations to the gastrocnemius muscle were disrupted (n = 32); and a transplantation group in which the denervated gastrocnemius was repaired with a common peroneal nerve graft into the muscle (n = 32). Neurofunctional behavior, including extensor postural thrust (EPT), withdrawal reflex latency (WRL), and compound muscle action potential (CMAP), as well as histological evaluations using alpha-bungarotoxin and anti-NF-200 were performed at 2, 4, 8, and 12 weeks (n = 8) after surgery. We found that EPT was improved by transplantation of the nerve grafts, but the EPT values in the transplanted animals at 12 weeks postsurgery were still significantly lower than those measured for the normal control group at 4 weeks (EPT, 155.0 -38.9 vs. 26.3 -13.8 g, p < 0.001; WRL, 2.7 -2.30 vs. 8.3 -5.5 s, p = 0.027). In addition, CMAP latency and amplitude significantly improved with time after surgery in the transplantation group ( p < 0.001, one-way analysis of variance), and at 12 weeks postsurgery, CMAP latency and amplitude were not statistically different from normal control values (latency, 0.9 -0.0 vs. 1.3 -0.7 ms, p = 0.164; amplitude, 30.2 -7.0 vs. 46.4 -26.9 mV, p = 0.184). Histologically, regeneration of neuromuscular junctions was seen in the transplantation group. This study indicates that transplanted nerve tissue is able to regenerate neuromuscular junctions within denervated muscle, and thus the muscle can recover partial function. However, the function of the denervated muscle remains in the subnormal range even at 12 weeks after direct nerve transplantation. These results suggest that tissue-engineered muscle, which is similarly denervated, could be innervated and become functional in vivo if it is properly integrated with the host nerve.

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Soft Tissue Management of War Wounds to the Foot and Ankle

Cited by 33 publications

References 66 publications

Improved vascular organization enhances functional integration of engineered skeletal muscle grafts

Improved vascular organization enhances functional integration of engineered skeletal muscle grafts

Extremity injuries in soldiers during the conflict in Mali: experience of Togo Level two Hospital

Functional Recovery of Completely Denervated Muscle: Implications for Innervation of Tissue-Engineered Muscle

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