Masquelet's induced membrane technique: Review of current concepts and future directions

Abstract

Masquelet's induced membrane technique (MIMT) is a relatively new, two-stage surgical procedure to reconstruct segmental bone defects. First performed by Dr. Masquelet in the mid-1980s, MIMT has shown great promise to revolutionize critical-sized bone defect repair and has several advantages over its alternative, distraction osteogenesis (DO). Also, its success in extremely challenging cases (defects > 15 cm) suggests that its study could lead to discovery of novel biological mechanisms that might be at play during segmental defect healing and fracture nonunion. MIMT's advantages over DO have led to a worldwide increase in MIMT procedures over the past decades. However, MIMT often needs to be repeated and so the average initial success rate in adults lags significantly behind that of DO (86% vs 95%, respectively). The autologous foreign-body membrane created during the first stage by the immune system's response to a polymethyl methacrylate bone cement spacer is critical to supporting the morselized bone graft implanted in the second stage. However, the biological and/or physical mechanisms by which the membrane supports graft to bone union are unclear. This lack of knowledge makes refining MIMT and improving the success rates through technique improvements and patient selection a significant challenge and hinders wider adoption. In this review, current knowledge from basic, translational, and clinical studies is summarized. The dynamics of both stages under normal conditions as well as with drug or material perturbations is discussed along with perspectives on high-priority future research directions.

The induced membrane technique in animal models: a systematic review

“…Accordingly, these investigations aimed primarily at analyzing the induced membrane. Such work has produced valuable knowledge about the membrane characteristics, observed under various conditions related to the first surgical stage [52,53] . However, this approach limits our understanding of how these conditions affect the ultimate outcome of bony healing after the second stage surgery.…”

“…Such work has produced valuable knowledge about the membrane characteristics, observed under various conditions related to the first surgical stage. [ 52 , 53 ] However, this approach limits our understanding of how these conditions affect the ultimate outcome of bony healing after the second stage surgery. The induced membrane is believed to play an essential role in the success of the technique by supporting healing in different ways, such as providing mechanical stability to the graft, and acting as a barrier to prevent soft tissue invasion.…”

“…The induced membrane is believed to play an essential role in the success of the technique by supporting healing in different ways, such as providing mechanical stability to the graft, and acting as a barrier to prevent soft tissue invasion. [ 54 ] The membrane is also vascularized and contains stem cells and growth factors (eg, BMP-2 and vascular endothelial growth factor), [ 52 , 53 ] which could contribute to graft viability and further promote healing. However, these presumed roles and contributions still need to be investigated thoroughly, in relation to bone healing outcomes.…”

Effects of PMMA spacer loaded with varying vancomycin concentrations on bone regeneration in the Masquelet technique

“…The three-dimensional structures of the bone defects were reconstructed using the Data Viewer (version 1.5.6.2) and Mimics Research (version 20.0) analysis software. The 3D reconstruction was used to blindly qualify each sample’s bridging as either united, unclear (obvious void) or empty, by one independent observer blinded to the grouping 24 , 25 . The bone volume (BV), total volume (TV), BV/TV, trabecular number (Tb.N), and trabecular thickness (Tb.Th) were analysed using CTAn (version 1.11) software.…”

Uso de ortobiológicos y aloinjerto en el tratamiento de pseudoartrosis con pérdida ósea diafisaria femoral

“…La falta de un estudio prospectivo comparativo con otros métodos de tratamiento en pseudoartrosis es evidente. 14,15 En la actualidad el enfoque en el tratamiento pone como piedra angular la base biológica. El plasma rico en plaquetas (PRP) es autólogo, no tóxico, ni inmunorreactivo, contiene una cuenta plaquetaria cinco veces mayor que la sangre normal.…”