Predicting Functional Deficits after Volumetric Muscle Loss in the Lower Extremity

Surgery; Biomechanics

This project will evaluate patients with Volumetric Muscle loss as a result of injury using multiple methods with the goal of predicting functional deficit resulting from the injury.

Research Interests

During the recent conflicts in Iraq and Afghanistan the percentage of surviving wounded continued to increase from previous wars due to improved body armor and rapid medical care and transport.  However many of the wounded warriors sustained extremity injuries and due to the high energy nature of the wounds there is often a significant component of Volumetric Muscle Loss (VML) which to date has limited treatment options, primarily bracing and physical therapy.  While we can identify grossly that VML has occurred and likewise can identify some effect on function, no study has yet been done to see if we can quantify the specific muscle lost and what effect this may have on the remaining muscle in the extremity and how we might target efforts to compensate or restore the lost function.  In the civilian world, VML can occur with open fractures, large lacerations, industrial accidents (including blasts and explosions) , and crush injuries.   This is planned as a pilot study of 15 patients who have sustained lower extremity VML as the result of an injury and who have a functional deficit.  The study involves identifying the specific VML through MRI, ultrasound, zebrascope (laser doppler to study sarcomere function) biodex strength testing and gait lab evaluation.  These will be performed at study initiation and 6 months later to evaluate functional improvement.  

Desired outcomes

If we can identify the specific injuries unique to each patient as well as the functional deficit related to these injuries then we can develop a personalized treatment plan to address the specific deficit which should lead to faster and ultimately better recovery from injury.  Obtaining pilot data on 15 patients would show the viability of this approach and allow pursuit of further funding primarily through the DOD.  The military has been very interested in treatment strategies for VML as a high percentage of wounded soldiers who are medically retired have musculoskeletal injuries and improved treatment would increase the ability of some of the wounded to return to active duty and lessen the permanent impairment of all the injured.  As new treatments for VML become available, having a validated approach to evaluation can also help determine the effectiveness of these treatments and perhaps identify focus areas for future research.