By Nathan Hurst, November 22, 2016
Injury is a sad fact of military service, especially in wartime. According to a study performed by scientists at the Uniformed Services University of the Health Sciences, by far the most frequent is soft tissue injuries to skin, fat and muscle.
Of these, muscle damage is particularly difficult to heal. Beyond a certain size—about one cubic centimeter—the body simply cannot do it. As a result, people experiencing this kind of trauma, called volumetric muscle loss, lose function of the muscle, and experience deformation, scar tissue or contracted muscles.
According to a study from 2015 in the Journal of Rehabilitation Research and Development (a peer-reviewed publication put out by the Department of Veterans Affairs), volumetric muscle loss is typically permanent.
“The current primary standard of care for [volumetric muscle loss] injuries is physical rehabilitation,” says Benjamin Corona, lead author of the study. “The documented cases available do not indicate significant functional recovery unless energy returning orthoses [braces or other devices] are used. Physical rehabilitation alone will not promote regeneration of the lost tissue.”
Corona and his team of researchers looked at the records of more than 500 service members who were discharged from the military due to injuries between 2001 and 2007. They found that most broken bones sustained in combat result in open wounds, and that while the bone can often be repaired, the muscle is left damaged. Service members who sustained broken bones are often disqualified from service not because of the break, but because of disability due to the soft-tissue wound.
“Despite a tremendous amount of attention given to bone healing after type III open tibia fracture, based on the current findings it is appropriate to conclude that soft-tissue complications make the majority contribution to disability of salvaged limbs,” the authors wrote. “The development of therapies addressing [volumetric muscle loss] has the potential to fill a significant void in orthopedic care.”
Historically, the best course of treatment was to use a flap of muscle, either from a different part of the body or rotated from a connected muscle, to cover the wound. This helps to heal, but cannot provide the normal use of an uninjured muscle, and so the limb where the injury occurred is often permanently disabled.