by Mark W. McFarland, DO
Most of us have had a bruise, muscle strain or sprain or a cut in our lives. However, most of us have never had an injury which opened our skin and sliced into our muscle. Thankfully, muscle laceration is the least common muscle injury. All lacerations, no matter how deep and severe, will develop scar tissue as a part of the natural healing process. Because muscle is a complex, fibrous tissue, healing usually takes a long time. The brain will send special cells to the injured muscle and slowly build a bridge of new tissue, called a collagen scaffold, across the dissected area. Repair cells are sent to fill in tissue across the scaffold. Some scar tissue will always form in this area. For deep and severe cuts, full restoration of the muscle to pre-injury strength and flexibility is hard to achieve. My job as an Orthopaedic Surgeon is to minimize scar tissue formation and help the patient to rehabilitate the muscle so it remains flexible after it heals.
It is important to learn about the injury and what caused it. A physical examination can help me to determine if bones or joints have also been damaged. X-rays can be helpful for imaging bones. Ultrasound, MRI or CT scan can assist in the determination and the extent of soft tissue injury. If nerve injury is suspected, an EMG may be ordered which checks nerve function and response.
All lacerations must be cleaned thoroughly to prevent infection. In a perfect world, we would only get cut by clean, sharp objects. However, many lacerations occur in unsanitary, outdoor environments, where rust, dirt and debris often infiltrate the wound with the jagged cutting object. It is imperative that the wound be properly debrided and irrigated to flush all foreign materials out before suturing. If a person has not had a recent tetanus vaccination, they will get one in order to prevent this severe complication.
For most muscle lacerations, I prefer to suture the muscle for better healing and less scar formation within the muscle. Using only immobilization to allow the muscle fibers to regenerate usually takes much longer and results in the development of more scar tissue. There has been a debate among physicians regarding which method of muscle repair allows for better healing and recent studies have proven that sutures work best.
Depending on the depth and severity of the cut, I can either suture it in my office or it may require a trip to the OR to repair. Concurrently, if bones are broken or joints dislocated, the fracture will have to be reduced and the joint returned to its natural position. This might be done in my office, after numbing the location of the injury or surgery may be needed, depending on the severity and location of the injury. Lacerations which cause the patient to lose consciousness due to shock or which result in significant blood loss should be handled in the ER.
A new way of repairing lacerated muscles involves the use of Platelet Rich Plasma (PRP) in the injured area. In the new and exciting field of Regenerative Medicine, autologously donated blood is being used in miraculous ways to heal musculoskeletal problems. PRP uses the patient’s own blood to deliver concentrated healing agents to the injured muscle. We are seeing levels of regeneration that were not previously achievable through surgery or immobilization alone.
Recovery from muscle laceration takes time and patience for the patient. The worse the laceration, the longer the resulting recovery will be. Patients are usually given antibiotics and pain medication and must rest to allow the muscle to heal. Bruising and swelling are common and ice may be used intermittently for the first 24-48 hours. Anti-inflammatory medications used to be given, but have fallen out of favor, as they may retard the natural healing process.
After about 6 weeks, slow and gentle stretching of the newly healed muscle begins. Physical Therapy can help the patient increase their strength and range of motion without overstressing the recovering muscle. Therapeutic ultrasound and laser treatments have been found beneficial in the stimulation of healing, as has use of hyperbaric oxygen chambers.
Complications may develop, such as:
- Severe Scarring or Keloid Formation
- Tearing of newly formed muscle tissue
No one wants to be the recipient of a muscle laceration. However, working together with a skilled orthopaedic surgeon, you can expect to see the best possible outcome and recovery.