Can a transected muscle be sutured?

Can a Transected Muscle Be Sutured?

Yes, a transected muscle should be surgically repaired with sutures, as this approach results in superior morphologic and functional healing compared to conservative management or immobilization alone.

Evidence for Surgical Repair

The decision to suture a transected muscle is supported by compelling biomechanical and functional data:

• Suturing a muscle laceration immediately after injury promotes better healing, prevents development of deep scar tissue, and results in significantly higher strength recovery compared to non-operative management 1
• In controlled studies, sutured muscles achieved 81% of baseline tetanus strength at 1 month, compared to only 35% for non-treated lacerations and 18% for immobilized muscles 1
• Surgical repair accelerates muscle regeneration, minimizes fibrotic scar formation, reduces hematoma formation, and achieves higher return to baseline strength 2

Optimal Suture Technique

When performing muscle repair, technique selection impacts outcomes:

• The Figure-eight suture technique is recommended as the optimal choice due to its superior biomechanical properties, simplicity, and efficiency 2
• The Figure-eight and Perimeter techniques demonstrate significantly higher stiffness compared to Mason Allen technique, with the Perimeter showing the highest peak failure point 2
• A modified Kessler stitch has been validated in animal models as producing excellent morphologic and functional healing 1
• The Figure-eight technique offers the fastest repair time while maintaining superior biomechanical strength 2

Special Considerations and Caveats

Extraocular Muscle Context

The ophthalmology literature provides important warnings about muscle transection complications:

• "Pulled-in-two syndrome" represents a challenging complication where intraoperative traction causes horizontal transection of the muscle belly 8-10mm from insertion; this transected muscle is both challenging to repair and further compromises functional alignment 3
• This complication is more common in adults with thyroid eye disease and fibrotic muscles 3
• When muscle transection occurs during surgery, meticulous technique with an experienced assistant and ample surgical time are essential 3

Technical Principles

• Sutures placed in nonmuscular scar tissue will lead to early failure; it is critical to distinguish robust muscle tissue from weak, nonmuscular attachments 3
• For skeletal muscle repairs, sutures can pull out easily from muscle belly, making the repair technically demanding 4
• Immediate repair is superior to delayed intervention for preventing scar tissue formation and optimizing functional recovery 1

Clinical Algorithm

1. Assess the injury: Determine location, extent of transection, and tissue quality
2. Prepare for repair: Ensure adequate exposure, experienced assistance if available, and appropriate suture material
3. Choose technique: Use Figure-eight suture technique for most skeletal muscle repairs 2
4. Execute repair: Place sutures through healthy muscle tissue, avoiding scar or necrotic tissue 3
5. Post-repair management: Follow conservative rehabilitation protocols with progressive strengthening 5

The evidence consistently demonstrates that surgical repair of transected muscles produces superior outcomes compared to conservative management, with specific suture techniques offering measurable advantages in strength and healing quality.