When Stitches Act Like Saws: Florida Surgeons Publish New Strategy for Severe Muscle Injuries
Plastic Surgery Trauma Associates announces publication in PRS Global Open of a scaffold-based repair technique developed for severe muscle injuries where stitches may cut through damaged tissue rather than hold it. In early clinical use, a first responder treated with SMART returned to duty after recovery.
DELRAY BEACH, Fla., June 16, 2026 /PRNewswire/ -- When muscle is completely severed, the problem is not only closing the wound. The problem is whether the repair can hold. Stitches placed through damaged muscle can behave like tiny saws, cutting through soft tissue under tension rather than pulling it together.
Surgeons at Delray Medical Center — a Level I trauma center in Florida — have published a scaffold-based reconstructive technique for selected severe muscle transection injuries where suturing alone may be mechanically unreliable. The technique, called SMART (Sandwiching Muscle Acellular Reconstruction Technique), was published in PRS Global Open, an open-access journal of the American Society of Plastic Surgeons.
The clinical experience was reviewed through applicable institutional oversight processes at Delray Medical Center, where the team treats complex traumatic wounds and severe soft-tissue injuries requiring urgent functional restoration. In early clinical use, the Delray team reports six cases across different anatomic regions, with no construct failures or wound complications reported during available follow-up. One first responder with a severe muscle injury that threatened his ability to work was treated with SMART and later returned to duty.
Unlike tendon, muscle is soft contractile tissue. Sutures placed directly through completely severed muscle under tension can cut through it rather than hold it. SMART addresses that failure point by placing paired biologic scaffolds — acellular extracellular matrix materials already in reconstructive use — on either side of the severed muscle. The construct acts as a load-sharing bridge, distributing force across the injury instead of concentrating tension at fragile stitch points.
Complete muscle transections have historically had limited acute reconstructive options. SMART was developed to address that gap. The technique was also presented at an international plastic surgery meeting focused on innovation in trauma and wound care, where it prompted discussion about the need for practical options in difficult muscle reconstruction.
The authors emphasize that SMART is an early technique for selected injuries, not a universal solution. Now that it is published, they hope it will be evaluated by other reconstructive and trauma teams to better define its indications, limitations, and long-term outcomes. Additional information is available at https://reconstructivetrauma.com/research-publications/
"Muscle is soft contractile tissue, not tendon. When sutures are placed directly through completely severed muscle under tension, they can behave like tiny saws and cut through the tissue," said Andrew Klapper, MD, plastic and reconstructive surgeon at Delray Medical Center. "We are encouraged because SMART may give surgeons a practical option for selected injuries where acute reconstructive options have historically been limited. It is still early and needs broader evaluation, but the goal is to support function, not simply close a wound."
"SMART is not about adding complexity," said Anthony Dardano, DO, Chief of Plastic Surgery at Delray Medical Center. "It is about using familiar reconstructive materials in a configuration that addresses a specific mechanical failure point in severe muscle trauma."
"Trauma care is not only about survival — it is about whether patients can return to work, independence, and normal life," said Peter Gonzalez, MD, Chief of Trauma at Delray Medical Center. "For injuries that historically had very limited acute options, SMART gives our team another strategy focused on restoring function."
ABOUT SMART
The Sandwiching Muscle Acellular Reconstruction Technique (SMART) is a scaffold-based reconstructive strategy for selected complete muscle transection injuries where suturing alone may fail under tension. Paired biologic scaffolds distribute force across the injured muscle rather than concentrating tension at fragile suture points.
Publication: Sandwiching Muscle Acellular Reconstruction Technique: An Early Feasibility Technique for Acute Skeletal Muscle Transection Stabilization, PRS Global Open
DOI: 10.1097/GOX.0000000000007755
Technique background: https://reconstructivetrauma.com/research-publications/
ABOUT THE SURGICAL TEAM
Andrew Klapper, MD is a plastic and reconstructive surgeon at Delray Medical Center specializing in trauma reconstruction, complex wound care, and surgical innovation.
Anthony Dardano, DO is Chief of Plastic Surgery at Delray Medical Center and a plastic and reconstructive surgeon involved in complex trauma and wound reconstruction.
Peter Gonzalez, MD is Chief of Trauma at Delray Medical Center.
Surgeon bios: https://reconstructivetrauma.com/our-surgeons/
PATIENT PRIVACY
Because the patient is a first responder, identifying details are withheld for privacy and safety. No name, agency, date of injury, location, mechanism, body part, or identifying photograph will be released. The patient reviewed the de-identified reference and provided written permission for its use.
SOURCE Plastic Surgery Trauma Associates
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