Abraham Saynes Jarquin

Muscle and tendon injuries remain among the most common causes of functional impairment and time-loss in elite athletes, representing a significant challenge for reconstructive surgery, sports medicine, and rehabilitation. Conventional treatment approaches frequently restore anatomical continuity but may not completely reproduce the biological and biomechanical properties of healthy tissue, increasing the risk of delayed recovery and recurrent injury. In recent years, biological augmentation has emerged as a promising strategy to enhance tissue regeneration through modulation of inflammation, stimulation of angiogenesis, promotion of extracellular matrix remodeling, and improvement of collagen organization. This narrative review critically examined current scientific evidence regarding the biological basis, clinical applications, and therapeutic potential of platelet-rich plasma, bone marrow aspirate concentrate, mesenchymal stromal cells, extracellular vesicles, exosomes, biomaterials, and tissue-engineered constructs for the management of muscle and tendon injuries in elite athletes. Current evidence suggests that platelet-rich plasma remains the most extensively investigated biological intervention, whereas cell-based therapies, biomaterials, and exosome-derived approaches continue to demonstrate considerable regenerative potential despite requiring further clinical validation. The findings also emphasize that successful recovery depends not only on biological augmentation but also on accurate diagnosis, individualized patient selection, technically sound reconstructive procedures, structured rehabilitation, progressive mechanical loading, and multidisciplinary clinical management. Although regenerative medicine continues to evolve rapidly, methodological heterogeneity among available studies highlights the need for standardized treatment protocols and large multicenter clinical investigations. Overall, biological augmentation represents a valuable adjunct to contemporary reconstructive strategies, offering new opportunities to improve tissue healing, functional recovery, and safe return to competitive sport in elite athletes.

Damage control surgery (DCS) has evolved from a trauma-focused strategy into an essential component of modern emergency general surgery for selected patients with non-traumatic abdominal emergencies. This review aimed to analyze the current scientific evidence regarding the expanding indications, physiological rationale, perioperative management, and clinical outcomes associated with DCS in conditions such as abdominal sepsis, acute mesenteric ischemia, severe acute pancreatitis, massive gastrointestinal hemorrhage, abdominal compartment syndrome, and vascular emergencies. A structured narrative literature review was conducted using the scientific method. Relevant publications were identified through PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, prioritizing systematic reviews, meta-analyses, clinical guidelines, international consensus statements, and high-quality observational studies. The reviewed evidence demonstrated that DCS is primarily indicated in patients with profound physiological instability characterized by hemodynamic compromise, metabolic acidosis, coagulopathy, hypothermia, severe intra-abdominal contamination, or uncertain bowel viability. Across the analyzed studies, the staged approach consisting of abbreviated surgery, temporary abdominal closure when required, intensive care resuscitation, planned re-exploration, and delayed definitive reconstruction was consistently associated with improved physiological recovery in carefully selected patients. However, postoperative complications including surgical-site infection, respiratory dysfunction, ventral hernia, and enteroatmospheric fistula remain important challenges requiring multidisciplinary management. Although current evidence supports the expanding role of DCS in non-traumatic emergencies, additional prospective multicenter studies are needed to standardize patient selection criteria and optimize clinical protocols. Overall, damage control surgery represents a physiology-guided strategy that has broadened therapeutic possibilities in emergency abdominal surgery while emphasizing individualized clinical decision-making and coordinated multidisciplinary care.