Research on Muscle Loss from Traumatic Injuries

In wartimes, military surgeons have their work cut out for them. More than 75 per cent of all injuries are to the limbs from explosions. Fractures, bone infections, and loss of soft tissue mass create chronic disability. In this report, experts from the military-based Skeletal Trauma Research Consortium bring us up-to-date on the problem of volumetric muscle loss or VML.

Volumetric muscle loss (VML) is defined as the loss of skeletal muscle and function from trauma or surgery. Although the focus is on combat-related extremity wounds, nonmilitary personnel (i.e., civilians) can experience the same type of injuries from high-energy trauma.

Even with the best of care, sometimes these injuries still create many disabling problems. With so many war injuries affecting the lower extremity (limb), military medicine is taking a closer look at volumetric muscle loss.

They have discovered that even after extensive reconstructive surgeries, many soldiers choose to have the leg amputated. They find that living without the weak, painful leg is actually easier than trying to work around all the functional deficits.

Now the task becomes how to evaluate volumetric muscle loss (VML) and track patient progress. That sounds easy enough until you try to do it. The VML injuries can be very different in type, severity, and location from patient to patient. But it’s important to find a way to characterize, describe, and measure VMLs so that members of the treatment team can communicate effectively with one another.

The military rehab team recommendations the following for evaluating volumetric muscle loss and its effects:

  • Divide injuries by upper extremity (arms and lower extremity (legs)
  • Divide limb injuries above and below the joint (above/below elbow for the arm, above/below knee for the leg)
  • Take photos and videos to document appearance, movement, strength, and function. Wound size, location, and severity can be shown this way. Loss of skin, soft tissue mass, and atrophy (wasting) of muscles can be documented this way as well.
  • Analyze videos of movement and gait (walking pattern) to aid in developing the plan-of-care.

    These guidelines are subject to change as rehab specialists (e.g., surgeons, physical and occupational therapists, orthotists, and prosthetists) in the military continue to develop this idea. Orthotists are the brace makers. Prosthetists make and fit artificial limbs.

    Gathering all of this information is important when the team selects the best management option for each patient. Volumetric muscle loss usually requires surgery. Muscle tissue is harvested from another part of the body to be used to make up for the lost mass. Bracing is often required afterwards to help stabilize and protect the joint. Therapists help patients regain motion, strength, and motor function.

    Scientists are studying ways to help tissue regenerate itself. Success in this area of study (called regenerative medicine) would be very helpful in cases of lost muscle mass.

    Engineers are also working with team members to develop powered bracing and prosthetic devices (artificial limbs). All of these tasks rely on accurate information about the body part in question. That’s where a standard protocol for assessing volumetric muscle loss comes in very handy. With measurements in hand, the team can get to work without having the patient on site for every meeting.

    In summary, missing muscle and soft tissue mass referred to as volumetric muscle loss is a big problem for soldiers and civilians alike following traumatic injuries. Efforts are being made to document the effect these injuries have so that better treatment outcomes can be developed.

    A standard assessment protocol should include photographs, video analysis, and tests and measures for motion, strength, and function. Any and all of these tools can be used to document before, during, and after injury effects and progress.