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Volumetric muscle loss (VML) is the irreversible loss of muscle tissue and function following a severe injury to skeletal muscle. It typically occurs suddenly due to a traumatic or surgical event, such as those experienced by soldiers wounded in combat missions or civilians injured in automobile accidents. The scale and severity of VML-associated injuries result in chronic inflammation and fibrosis that surpass the endogenous regenerative capacity of skeletal muscle. The current treatment for VML is based on surgical conservative treatment followed by physical exercise, but the results are often poor.
| Characteristics | Values |
|---|---|
| Definition | The irreversible loss of muscle tissue and function following severe injury to skeletal muscle |
| Other names | Volumetric Muscle Loss (VML) |
| Causes | Traumatic or surgical events, such as combat missions or automobile accidents |
| Treatment options | Functional free muscle transfer, advanced bracing designs, surgical conservative treatment, physical exercise |
| Potential future treatment options | Powered bracing, regenerative medicine, reconstructive therapy, biomimetic matrix or artificial tissue implantation |
| Diagnosis | Clinical photographs, video recordings, range of motion measurements, manual muscle strength testing, isokinetic muscle function testing |
| Complications | Chronic dysregulated inflammation and fibrosis, increased susceptibility of surrounding tissue to further injury |
| Severity | Loss of 20% or more of total muscle mass |
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What You'll Learn
- Volumetric muscle loss (VML) is the traumatic or surgical loss of skeletal muscle
- VML results in functional impairment and significant tissue damage
- Current treatments include muscle transfer and bracing, but results are poor
- Reconstructive therapy aims to replenish muscle volume with artificial tissue implantation
- VML can occur suddenly due to traumatic events, such as combat or car accidents
Volumetric muscle loss (VML) is the traumatic or surgical loss of skeletal muscle
VML is characterised by chronic dysregulated inflammation and fibrosis that surpass the endogenous regenerative capacity of skeletal muscle. The exacerbated fibrosis within the muscle disrupts the functional and structural properties of the remaining tissue and can increase the susceptibility of surrounding tissue to further injury. Treatment strategies that are currently available, such as autologous tissue transfer (muscle grafts) and physical therapy, are not effective at restoring muscle function. Autologous muscle grafts are invasive, may cause donor site morbidity, and may not be a viable option for all patients.
The actual treatment for VML is based on surgical conservative treatment followed by physical exercise. However, the results, in terms of lost mass and/or functionality recovery, are still poor. Efforts in the scientific community are focusing on reconstructive therapy to build new muscular tissue and replenish muscle void volume by exploiting biomimetic matrix or artificial tissue implantation. Other potential treatments include functional free muscle transfer and the use of advanced bracing designs. Advances in powered bracing and regenerative medicine may also provide additional therapeutic options in the future.
Further research on VML is warranted, and several studies have been conducted on animal models, including rats and swine. These studies have explored the use of biomimetic scaffolds, hydrogels, and microvascular constructs for muscle regeneration.
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VML results in functional impairment and significant tissue damage
Volumetric muscle loss (VML) is the extensive and quick loss of 20% or more of the total amount of muscle mass. This results in significant and persistent impairment beyond the normal capacity of regeneration of the tissues. VML is the traumatic or surgical loss of skeletal muscle with resultant functional impairment. It typically occurs suddenly due to a traumatic or surgical event, such as those experienced by soldiers wounded in combat missions or civilians in automobile accidents.
The scale and severity of VML-associated injuries results in chronic dysregulated inflammation and fibrosis that surpass the endogenous regenerative capacity of skeletal muscle. The exacerbated fibrosis within the muscle disrupts the functional and structural properties of the remaining tissue and can increase the susceptibility of the surrounding tissue to further injury. In addition to alterations in muscle tissue function, the extensive muscle loss associated with this condition overwhelms the muscles' endogenous ability to self-regenerate.
Treatment strategies that are currently available, such as autologous tissue transfer (i.e. muscle grafts) and physical therapy, are not effective at restoring muscle function. Autologous muscle grafts are invasive, may cause donor site morbidity, and can have complications that result in complete graft failure (e.g. necrosis and infections). They are not a viable option for all patients. The actual treatment for VML is based on surgical conservative treatment followed by physical exercise; nevertheless, the results, in terms of lost mass and/or functionality recovery, are still poor.
The scientific community is focusing on reconstructive therapy aiming at muscular tissue void volume replenishment by exploiting biomimetic matrix or artificial tissue implantation. Reconstructing strategies represent a valid option to build new muscular tissue, not only to recover damaged muscles but also to better socket prosthesis in terms of anchorage surfaces and reinnervation substrates for reconstructed mass.
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Current treatments include muscle transfer and bracing, but results are poor
Volumetric muscle loss (VML) is the traumatic or surgical loss of skeletal muscle, resulting in functional impairment. It can be caused by orthopaedic trauma or the surgical removal of skeletal muscle. The loss of muscle tissue leads to substantial deficits in joint range of motion and skeletal muscle strength, which may cause lifelong dysfunction and disability.
Current treatment options include functional free muscle transfer and the use of advanced bracing designs. Muscle transfer involves the use of muscle grafts and tissue-engineered muscle products. However, these treatments have limited success due to the lack of an appropriate nerve supply, which is crucial for muscle function. The success of muscle transfer is further limited by donor-site morbidity, extensive operation time, and the need for muscles to remain without nerve attachments for an extended period.
Bracing, another current treatment option, involves the use of advanced bracing designs to support and stabilize the affected area. While bracing can provide structural support, it does not address the underlying muscle loss or functional impairment.
Overall, the results of current treatments for VML are poor in terms of both lost mass recovery and functionality restoration. There is a need for further research and the development of alternative treatment approaches to improve outcomes for individuals suffering from VML.
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Reconstructive therapy aims to replenish muscle volume with artificial tissue implantation
Volumetric muscle loss (VML) is the extensive wasting of skeletal muscle tissue due to traumatic events or surgical ablation. It typically occurs suddenly, such as in the case of soldiers wounded in combat missions or civilians injured in automobile accidents. The scale and severity of VML-associated injuries result in chronic inflammation and fibrosis that surpass the endogenous regenerative capacity of skeletal muscle.
Current treatment options include functional free muscle transfer and the use of advanced bracing designs. However, these treatments are not effective at restoring muscle function and may cause donor site morbidity. As a result, the scientific community is focusing on reconstructive therapy to replenish muscle volume with artificial tissue implantation.
The actual treatment for VML typically involves surgical conservative treatment followed by physical exercise. However, the results in terms of lost mass and functionality recovery are often poor. Clinical photographs, video recordings, range of motion measurements, and muscle strength and function testing are used to document VML.
In conclusion, VML is a severe condition that results in extensive muscle loss and functional impairment. While current treatment options are limited, reconstructive therapy with artificial tissue implantation shows potential in replenishing muscle volume and improving outcomes. Further research and optimization are warranted to enhance recovery from VML.
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VML can occur suddenly due to traumatic events, such as combat or car accidents
Volumetric muscle loss (VML) is the extensive damage and quick loss of skeletal muscle tissue, resulting in functional impairment. VML can occur suddenly due to traumatic events, such as combat or car accidents, or surgical procedures. The scale and severity of VML-associated injuries result in chronic dysregulated inflammation and fibrosis that surpass the endogenous regenerative capacity of skeletal muscle. The muscle's ability to self-regenerate is overwhelmed by the extensive muscle loss, and the exacerbated fibrosis within the muscle disrupts the function and structure of the remaining tissue.
Traumatic events, such as those experienced in combat or car accidents, can lead to VML. For instance, soldiers wounded in combat missions may suffer severe injuries to their skeletal muscles, resulting in VML. Similarly, civilians involved in automobile accidents can experience sudden and traumatic muscle loss. In these situations, the initial injury to the skeletal muscle is often accompanied by secondary injuries to nerves, tendons, bones, and blood vessels, further complicating the condition.
The treatment for VML typically involves surgical procedures followed by physical exercise. However, the results in terms of lost mass recovery and functionality restoration are often poor. Current treatment options include functional free muscle transfer and advanced bracing designs. While these treatments aim to address the functional impairment caused by VML, they do not always lead to satisfactory outcomes.
To improve treatment outcomes, the scientific community is exploring reconstructive therapies. These therapies focus on replenishing the void volume in the muscular tissue by using biomimetic matrices or artificial tissue implantation. Such approaches not only aid in repairing damaged muscles but also enhance the anchorage surfaces and reinnervation substrates for reconstructed mass. Additionally, advances in powered bracing and regenerative medicine hold potential for providing additional therapeutic options in the future.
The assessment and quantification of VML can be challenging due to the lack of a standardized evaluation protocol. Clinical photographs, video recordings, range-of-motion measurements, manual muscle strength testing, and isokinetic muscle function testing are some of the methods used to document and understand the extent of VML. Further research and the development of new strategies are crucial to optimizing recovery and enhancing the effectiveness of treatments for individuals suffering from VML due to traumatic events.
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Frequently asked questions
Volumetric muscle loss (VML) is the extensive and quick loss of 20% or more of the total amount of muscle mass. It is often caused by traumatic or surgical events.
The symptoms of VML include significant and persistent functional impairment beyond the normal capacity of regeneration of the tissues. This can include chronic dysregulated inflammation and fibrosis that surpasses the endogenous regenerative capacity of skeletal muscle.
Treatment for VML typically involves surgical conservative treatment followed by physical exercise. However, results in terms of lost mass and functionality recovery are often poor. Other treatment options include functional free muscle transfer and the use of advanced bracing designs.
Volumetric muscle loss is typically caused by traumatic or surgical events. This can include soldiers wounded in combat missions or civilians injured in automobile accidents.
Advances in powered bracing and regenerative medicine may provide additional therapeutic options in the future. For example, reconstructive therapy aims to replenish muscular tissue void volume by exploiting biomimetic matrix or artificial tissue implantation.
