Clark, Andrew R.Kulwatno, JonathanKanovka, Sergey S.Klarmann, George J.Hernandez, Claudia E.Natoli, Roman M.McKinley, Todd O.Potter, Benjamin K.Dearth, Christopher L.Goldman, Stephen M.2024-08-232024-08-232024-06-06Clark AR, Kulwatno J, Kanovka SS, et al. A Two-Stage Approach Integrating Provisional Biomaterial-Mediated Stabilization Followed by a Definitive Treatment for Managing Volumetric Muscle Loss Injuries. J Funct Biomater. 2024;15(6):160. Published 2024 Jun 6. doi:10.3390/jfb15060160https://hdl.handle.net/1805/42911Treatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in combat settings. To this end, polyvinyl alcohol (PVA) was used at concentrations of 5%, 7.5%, and 10% to generate provisional muscle void fillers (MVFs) of varying stiffness values (1.125 kPa, 3.700 kPa, and 7.699 kPa) to stabilize VML injuries as part of a two-stage approach. These were implanted into a rat model for a duration of 4 weeks, then explanted and either left untreated (control) or treated through minced muscle grafting (MMG). Additional benchmarks included acute MMG and unrepaired groups. At the MVF explant, the 7.5% PVA group exhibited superior neuromuscular function compared to the 5% and 10% PVA groups, the least fibrosis, and the largest median myofiber size among all groups at the 12-week endpoint. Despite the 7.5% PVA’s superiority amongst the two-stage treatment groups, neuromuscular function was neither improved nor impaired relative to acute treatment benchmarks. This suggests that the future success of a two-stage VML treatment strategy will necessitate a more effective definitive intervention.en-USAttribution 4.0 InternationalSkeletal muscleTraumaOrthopedicsMilitary medicinePolymersArticle