**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 guaran‐ teed 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.

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.

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.

© 2013 Cerulli et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

of the surrounding tissue that drive the neo-tissue to organize in the most functional way possible for contraction. The connective tissue produced is partly demolished, gradually

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http://dx.doi.org/10.5772/56736

**Figure 1.** The diagram summarizes the three phases of muscle laceration healing. Note that reparation has a peak

Fibroblasts that colonize the lesion and produce extracellular matrix play a key role in lesion healing. The connective tissue that is formed fills the gap created by the lesion with a threedimensional plot that not only guides the proliferation of muscle cells and blood, but allows the transmission and the distribution of mechanical stresses thus acting as a sort of brace and allowing the functional use of the muscle before the lesion is completely healed. It was observed that animal muscles, thanks to this connective tissue, already after 14 days the scar that had formed in complete tears was mechanically more resistant than the surround‐ ing muscle [4]. It should be kept in mind that in human tissue healing times are longer and recovery is less complete but the sequence and function of the repair steps are the

This scar tissue is extremely important but it can also be an obstacle to proper healing: in fact, if there is too much of it, instead of promoting, it may prevent tissue proliferation leading to incomplete recovery [3]. A proper healing of muscle tissue is centered on the correct balance between fibroblastic proliferation and myoblast proliferation: the first promote the connective

around the second week and concludes by the third- fourth week [2].

same [5].

leaving more space for the connections between the myofibers [4].

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.
