Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Abstract

Departmental sources Background: Infected bone defects are therapeutic challenges. Although the induced membrane technique has been used for this problem, there is a 3% to 20.7% failure to eradicate infection, and there have been few reports about its use in tuberculous infection. We present our three-stage induced membrane technique (TSIMT) for treating infected bone defects of the lower extremity. Material/Methods: Forty-one adult patients with infected bone defects of the lower extremities treated by TSIMT were included in a retrospective case-series study between January 2013 and June 2018. The clinical, imaging and laboratory assessment outcomes were analyzed. Results: In the first stage, 3 patients had ankle tuberculous bone defects and 17 patients underwent 2-4 debridements. In the second stage, the average bone defect was 6.0 cm; 1 patient needed an anterolateral thigh flap to cover the wound. In the third stage, 10 patients underwent autograft mixed allograft, and 18 cases used internal fixation. The mean follow-up period was 23.3 months. All patients achieved bone union and clinical eradication of infection. Changes in Lower Extremity Functional Scale (LEFS) scores after 1 year of TSIMT and bone union time are associated with advanced age, longer duration of infected bone defects, active smoking, and external fixation (p<0.05), but are not dependent on bone defect size, debridement times, type of bone graft, or spacer-placing time (p>0.05). Conclusions: TSIMT is effective in treating infected bone defects of the lower extremities. Advanced age, longer duration of infected bone defects, active smoking, and external fixation adversely affect bone union and recovery of infected extremities in a limited time span.

Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction

“…Thus, IMT must only be deployed once any infection is definitively eradicated or at least brought under control. In cases of infected bone defect, a prior IMT stage 0 is then crucial before cement spacer implantation [4,31]. Stage 0 includes multiple consecutive procedures: removal of eventual internal fixation material, radical debridement of infected tissue, copious irrigation, and temporary stabilization by external fixation.…”

A meta-analysis of the Masquelet technique and the Ilizarov bone transport method for the treatment of infected bone defects in the lower extremities

“…The management of infected bone defects, mostly caused by high-energy trauma, 1 is one of the most challenging problems in the field of orthopedics. 2 Infection control and bone defect repair are important in the treatment process; improper therapy may cause ongoing infection at the fracture site, increase the risk of complications, and even result in amputation. 3 Generally, the Masquelet technique 4 and Ilizarov bone transport 5 method are recognized as common treatment methods for the management of infected bone defects in the lower extremities.…”

Favorable osteogenic activity of iron doped in silicocarnotite bioceramic: In vitro and in vivo Studies

“…Improving new bone formation in patients with bone defects is therefore one of the major challenges faced by orthopedic surgeons. In response, a large variety of bone grafts, for instance, allografts, autografts and xenografts, have been proposed, that can substantially increase bone formation and improve clinical outcomes [ 4 ]. However, these bone grafts have certain disadvantages, such as donor-site morbidity, difficulty in obtaining autografts, and disease spread and rejection in allografts and xenografts [ [5] , [6] , [7] , [8] , [9] ].…”