Plast Reconstr Surg Glob Open · 2026
SMART Muscle Repair
A technique for stabilising acute full-thickness skeletal muscle transection, in which acellular dermal matrix is used to sandwich the transected muscle ends and restore immediate mechanical continuity.
Citation
Andrew Mark Klapper, MD; Anthony N. Dardano, DO, FACS; Gustavo M. Huaman, MD; Gustavo G. Huaman, BS, MHA, MS. Sandwiching Muscle Acellular Reconstruction Technique: An Early Feasibility Technique for Acute Skeletal Muscle Transection Stabilization. Plast Reconstr Surg Glob Open. 2026;14(5):e7755. doi:10.1097/GOX.0000000000007755.
PubMed 42199247 →Publisher →PubMed Central →
The problem
Skeletal muscle divided through its full thickness has historically had few durable repair options. Suture placed into muscle tends to cut through it under load, so a repair that holds on the table may not hold once the muscle contracts.
The technique
SMART — the Sandwiching Muscle Acellular Reconstruction Technique — addresses that by sandwiching the transected muscle ends between layers of acellular dermal matrix, distributing load across the repair rather than concentrating it at suture points, and restoring immediate mechanical continuity.
What the paper reports
The published series describes constructs applied in 3 trauma cases across distinct anatomical regions, following debridement and antibiotic irrigation. All repairs achieved immediate mechanical continuity without infection or early construct failure, and tolerance of protected motion was observed clinically within eight to twelve weeks.
The paper describes early technical feasibility. It is not a comparative trial, and the case numbers above are what the peer-reviewed record states.
Illustrations from the technique
