Biocompatible and stretchable piezoelectric elastomer based on lactic acid for synchronous repairing and function monitoring of volumetric muscle loss

The treatment of volumetric muscle loss (VML) and the real-time monitoring of damaged muscle function have long posed challenges for clinicians. The novel in-situ electric stimuli therapy using piezoelectric materials for VML repairing has attracted numerous attentions. However, the reciprocating motion of the muscle requires the piezoelectric materials with both high piezoelectricity and stretchability. In this study, a biocompatible piezoelectric elastomer (VMLRE) was synthesized through the copolymerization of several bio-based diacids and diols. By controlling the chemical compositions and chain structure, the VMLRE possess elastic modulus accurately matching with that of muscle tissue, allowing the reciprocal deformation during muscle movements to realize function recovery evaluating. The backbone of VMLRE is enriched with C[dbnd]O dipoles to achieve excellent piezoelectric properties, which enable converting mechanical stimuli generated by physical activity into electrical energy, providing real-time and in situ electrical stimulation. The electric stimulation promotes myoblast proliferation and differentiation by potentially activating calcium/calmodulin signaling pathways, facilitating cell migration, and enhancing neovascularization. Consequently, the rate of VML repair is significantly improved. Our innovative piezoelectric elastomer enables simultaneous repair and real-time biofeedback monitoring of VML, offering a novel strategy for the treatment of volumetric muscle loss.