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SMART Muscle Repair
When repair itself fails.
The problem
A muscle divided across its full thickness has to be held together while it heals. The difficulty is that the repair is loaded from the moment it is made, and muscle is not a material that holds a stitch well.
Sutures concentrate force onto a small area of soft tissue. Under contraction they tend to pull through the muscle rather than hold it — which is the observation the technique is named for, and the reason a repair that looked sound in theatre can fail afterwards.
The approach
SMART — the Sandwiching Muscle Acellular Reconstruction Technique — places acellular dermal matrix on either side of the transected muscle ends, sandwiching them so mechanical continuity is restored immediately and the load is not carried by suture alone.
A · Original peer-reviewed publication
Sandwiching Muscle Acellular Reconstruction Technique: An Early Feasibility Technique for Acute Skeletal Muscle Transection Stabilization
- Journal
- Plastic and Reconstructive Surgery — Global Open
- Published
- May 2026
- Type
- Journal Article
- Authors
- Klapper AM, Dardano AN, Huaman GM, Huaman GG
- Volume
- 14(5), e7755
- PMID
- 42199247
- DOI
- 10.1097/GOX.0000000000007755
PubMed →Journal →Full text →ORCID →
First peer-reviewed description of SMART Muscle Repair, 2026.
B · Published clinical series
What the paper reports
Reported across 3 cases in the original publication.
- 0construct failures
- 0infections
- 8–12weeks to protected motion
These figures describe the 3 cases in the publication above and nothing else. They are an early feasibility report, not a predictor of any individual result, and they are not carried forward onto later patients.
C · Current clinical experience
Since publication
The cumulative number of repairs performed since publication is not stated here, because no validated count has been produced.
Cumulative experience is a different quantity from the published series. Combining the two — applying the outcomes of layer B to the larger denominator of layer C — would assert something no one has analysed. A figure will appear here when it has been counted and checked, and not before.
D · Press / media
When Stitches Act Like Saws: Florida Surgeons Publish New Strategy for Severe Muscle Injuries
National distribution announcing the peer-reviewed publication of SMART Muscle Repair in Plastic and Reconstructive Surgery — Global Open, and its early clinical use at Delray Medical Center.
The release reports six early cases, reflecting the clinical experience available when it was issued in June 2026. That is not the denominator of the published series, and it is not the current cumulative experience.
Wire distribution and potential-reach figures from the PR Newswire report. Carriage of a release is not independent editorial coverage.
A press release is media coverage. It is not peer review, and nothing in it should be read as scientific evidence.
Context
SMART is the most recent of several attempts at the same kind of problem. The pattern it belongs to — salvaging or reinforcing tissue that conventional handling gives up on — runs back through earlier techniques.
This page provides general educational information about a surgical technique and is not individualized medical advice. It does not describe what is appropriate for any particular person, and no outcome is implied or guaranteed. Clinical questions should go to the practice. See the clinical disclaimer.