Induced-Membrane Technique in the Management of Posttraumatic Bone Defects

Abstract

Background: Critical-size bone defects are defined as bone defects where spontaneous regeneration is not expected without treatment 1. The characteristics of bone defects (etiology, location, size, presence of infection, and softtissue conditions) vary greatly and, to be effective, the treatment method should address this variability. The induced-membrane technique, or Masquelet technique, is a method for treating critical-size bone defects 2,3 of various sizes and anatomic locations. It has been used to treat infected and noninfected bone defects and may be performed with a variety of fixation methods 2,3. Description: The induced-membrane technique is a 2-stage procedure. The first stage consists of debridement followed by insertion of a polymethylmethacrylate (PMMA) spacer in the bone defect. The presence of the PMMA leads to a foreign-body reaction with the development of a thick pseudosynovial membrane that is extremely vascularized and rich in growth factors. The filling of the bone defect with the cement spacer prevents fibrous tissue invasion and allows the development of an optimal vascularized gap for bone-grafting. After 6 to 8 weeks, the membrane around the spacer is carefully opened for the removal of the spacer, which is then replaced by bone graft 2,3 , which can be expanded with allograft or biomaterials. Alternatives: Alternatives include vascularized or nonvascularized autologous bone graft, allograft, bone transport methods, titanium cages, megaprostheses, shortening, and amputation. Rationale: Posttraumatic bone defects frequently are associated with soft-tissue injury and infection that impair the local vascularization and the healing potential. The highly vascularized induced membrane may play a role in restoring the local regenerative capacity. Numerous studies have demonstrated its successful use in the treatment of posttraumatic bone defects in the hand, forearm, humerus, femur, tibia, and foot. The induced-membrane technique is especially advantageous in the treatment of infected bone defects because the presence of the spacer helps in the treatment of the infection by reducing dead space, acting as a local antibiotic carrier, and promoting some degree of bone stability 3-5 .

Decompression Surgery With Antibiotic-impregnated Calcium Sulfate Can Achieve More Satisfactory Results Than Decompression Alone in Pediatric Hematogenous Osteomyelitis

“…Masquelet [32] proposed two steps operation technique for the treatment of chronic osteomyelitis. First step is a sharp debridement of necrotic tissue, abundant lavage, sequestrectomy, and removal of any hardware and/or foreign bodies, followed by insertion of antibiotic-impregnated Polymethylmethacrylate(PMMA).…”

Towards Understanding Therapeutic Failures in Masquelet Surgery: First Evidence that Defective Induced Membrane Properties are Associated with Clinical Failures

“…IMT is considered as the method of choice to address posttraumatic or infected segmental bone loss [13,26]. Regardless of the heterogeneity and features of study populations (age, sex, smoking…) and fractures (osteosynthetic materials, causes of segmental defects…), numerous studies agreed that the IM is the key element of the surgery as it creates a biologically privileged-environment for bone healing [4,10,22,24].…”

“…IMT is considered as the method of choice to address posttraumatic or infected segmental bone loss [13,26]. Regardless of the heterogeneity and features of study populations (age, sex, smoking .…”

Reconstruction of Large Skeletal Defects: Current Clinical Therapeutic Strategies and Future Directions Using 3D Printing

“…This membrane has various functions, in particular it prevents the resorption of the cancellous bone graft, supports vascularization and corticalization, and functions as a delivery system for osteomodulatory and angiogenic growth factors like transforming growth factor (TGFβ), bone morphogenetic protein 2 (BMP2) and vascular endothelial derived growth factor (VEGF) (Masquelet, 2003;Pelissier et al, 2004;Masquelet and Begue, 2010). This innovative technique is indicated in acute and chronic infected or non-infected massive bone defects of any size (4-25 cm) and shape, at different anatomical sites in children and adults (Masquelet et al, 2000;Azi et al, 2019). Its consolidation rate varies from 82 to 100% with delays ranging from 4 months to 1 year.…”