Sandwiching Muscle Acellular Reconstruction Technique: An Early Feasibility Technique for Acute Skeletal Muscle Transection Stabilization

Summary: Functional reconstruction of transected skeletal muscle remains an unsolved challenge in trauma and reconstructive surgery. Full-thickness skeletal muscle loss from trauma often precludes primary repair. Conventional methods restore coverage but rarely reestablish anatomical or functional continuity. The sandwiching muscle acellular reconstruction technique (SMART) uses dual extracellular matrix biologic scaffolds to bridge acute muscle defects. Constructs were applied in 3 trauma cases across distinct anatomical regions following debridement and antibiotic irrigation. Clinical assessment included bedside examination and Medical Research Council grading. All repairs achieved immediate mechanical continuity without infection or early construct failure. Tolerance of protected motion was observed clinically within 8–12 weeks across cases. SMART demonstrates early technical feasibility as a stabilizing approach for acute full-thickness skeletal muscle transections and provides a foundation for structured prospective evaluation using objective endpoints.