1. Introduction
Muscular tissue has a good ability to regenerate that promotes the healing of lesions also extended, caused by strains, contusions and muscle lacerations. This characteristic is guaranteed by myogenic precursor cells (satellite cells) that proliferate and fill the structure of the extracellular matrix produced by fibroblasts becoming myoblasts.
Several factors make difficult the healing of the lesion: hematoma, granulation tissue, scar tissue and lesions of nerve bundles. In ’84 Garret et al. [1] have shown that the tissue recovery was obstructed by a large percentage of denervated myocytes distal to the lesion.
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A well-executed suture could allow early rehabilitation with a lower risk of re-rupture and stitch pullout. The main problem is figuring out which is the best surgical technique, but especially when a surgical repair is necessary and if the benefits outweigh the disadvantages.
In the choice of surgical technique are many points still debated. The surgical indication is very limited and, in most of the muscle injury, conservative treatment is certainly indicated. Location and extent of the lesion are the criteria most examined in the literature.
Some of the few in vivo studies on animals have shown that a surgical suture of the wound can accelerate healing. The myorrhaphy prevents the formation of excess scar tissue, limits the hematoma formation, decreases the infiltration of mononuclear cells, increases the number of regenerating myofibers, decreases the inflammatory response favoring the healing.
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For example, lesions of the pectoralis major muscle have wider surgical indication and conservative treatment is recommended only in cases of injury at the sternoclavicular origin, in some partial tears, in older or sedentary individuals.
Some authors tend to wide the indication for surgical treatment to lesions greater than 50% of the thickness of the muscle belly and the debate is still open because of the few tests to date available, but certainly the indication is strengthened by the absence of synergistic muscles that can decrease the workload to the muscle and therefore aid healing.
The aim of this chapter is to perform a review of the literature in order to identify the muscle injury which indicate surgical treatment and its results.
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