Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction

Ac, Masquelet

doi:10.1007/s00423-003-0379-1

Cited by 205 publications

(152 citation statements)

References 18 publications

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“…There have been a few small series, however, in which tibial bone loss up to 25 cm in length has been treated successfully with cancellous bone grafting (Christian et al 1989, Watson et al 1995, Masquelet 2003, Schlötte et al 2005. In the study of Masquelet (2003), the time of bone healing was found to be independent of the extent of the bone loss, and our results are in accordance with this.…”

Section: Discussionsupporting

confidence: 88%

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Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

et al. 2007

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IntroductionThe vascularity of surrounding soft tissues, which is related to muscle cover, is important for the healing of traumatic bone loss. Muscle cover on the distal tibia is limited compared to the diaphyseal and proximal tibia, and delayed healing of fractures in this area is common. We evaluated the healing of traumatic bone loss in the proximal, diaphyseal, and distal tibia.Patients and methods 23 open tibial fractures with substantial bone loss (mean 52 (34-104) mm) were treated using a staged method with antibiotic-impregnated beads and later autologous bone grafting at second-stage surgery on average 8 weeks after the injury.Results 22 fractures healed after mean 40 (20-79) weeks. The average healing time in the distal tibia (mean 30 weeks) was 7 weeks shorter (95% CI: 12-26 weeks) than in the proximal tibia (37 weeks), and 16 weeks shorter (95% CI: 3-29 weeks) than in the tibial shaft (47 weeks). The length of the bone and the type of soft tissue cover (free muscle or secondary suture) had no effect on healing time.Interpretation Our study suggests that the method we used is applicable in all parts of the tibia, although the healing of bone loss is slower in the diaphyseal tibia than in the proximal and distal tibia.

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Section: Discussionsupporting

confidence: 88%

“…Christian et al (1989) were the first to describe the method of using antibiotic-impregnated beads as a spacer. Masquelet (2003) used methylmetacrylate cement for the same purpose. Both the beads and the cement spacer induce development of a surrounding synovium-like foreign body membrane, which has both a mechanical and a biological role.…”

Section: Discussionmentioning

confidence: 99%

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

et al. 2007

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“…The first step comprises soft tissue and bone debridement with implantation of a cement spacer that induces a pseudosynovial membrane, stabilization of the bony segment with a stable fixation, and soft tissue coverage or free tissue transfer. The second step is performed approximately 2 months later and comprises removal of the cement spacer and filling of the cavity with cancellous bone graft and bone substitutes [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…This prevents graft resorption by inducing vascularization and provides growth factors, it is a two-step procedure. The first step includes an extensive excision of infected and non-viable tissue, it is followed by careful stabilization of the bone and placement of cement spacer in the bone defect .and covered with a flap if required .The second step is performed at least 6 to 8 weeks after the first step, it includes removing the spacer and filling the biological space which has been created with cancellous graft or bone substitutes [1][2][3][4].…”

mentioning

confidence: 99%

Masquelet Technique for Reconstruction of Extensive Bone Defect of Tibia after Gunshot Injury in a Child: Case Report

Fannouch¹,

Alfaisali²,

Bobseit³

et al. 2018

MOJOR

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Reconstruction of extensive traumatic bone loss in children especially after gunshot injury represents a complex and challenging clinical entity with significant long-term morbidity. In 1986, A.C. Masquelet conceived and developed an original reconstruction technique for large diaphyseal bone defects, based on the notion of the induced a pseudo-membrane, This technique will be described in our case report.

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“…1,2 Masquelet describes induced membranes as an ''in situ growth factor delivery system'' and many subsequent studies have demonstrated the intrinsic bioactivity of membranes grown around PMMA space maintainers. 1,3 Intrinsic membrane factors that can ultimately promote bone growth in the second reconstructive stage include osteogenic and angiogenic growth factors and pro-and anti-inflammatory cytokines. [3][4][5] The presence of these factors has been demonstrated in both human and animal induced membranes over PMMA.…”

Section: Introductionmentioning

confidence: 99%

Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect

Shah

Smith

Tatara

et al. 2017

Tissue Engineering Part A

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Reconstruction of large bone defects can be complicated by the presence of both infection and local antibiotic administration. This can be addressed through a two-stage reconstructive approach, called the Masquelet technique, that involves the generation of an induced osteogenic membrane over a temporary poly(methyl methacrylate) (PMMA) space maintainer, followed by definitive reconstruction after the induced membrane is formed. Given that infection and antibiotic delivery each have independent effects on local tissue response, the objective of this study is to evaluate the interaction between local clindamycin release and bacterial contamination with regards to infection prevention and the restoration of pro-osteogenic gene expression in the induced membrane. Porous PMMA space maintainers with or without clindamycin were implanted in an 8 mm rat femoral defect model with or without Staphylococcus aureus inoculation for 28 days in a full-factorial study design (four groups, n = 8/group). Culture results demonstrated that 8/8 animals in the inoculated/no antibiotic group were infected at 4 weeks, which was significantly reduced to 1/8 animals in the inoculated/antibiotic group. Quantitative polymerase chain reaction analysis demonstrated that clindamycin treatment restores inflammatory cytokine and growth factor expression to the same levels as the no inoculation/no antibiotic group, demonstrating that clindamycin can ameliorate the negative effects of bacterial inoculation and does not itself negatively impact the expression of important cytokines. Main effect analysis shows that bacterial inoculation and clindamycin treatment have independent and interacting effects on the gene expression profile of the induced membrane, further highlighting that antibiotics play an important role in the regeneration of infected defects apart from their antimicrobial properties.

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Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction

Abstract: In weight-bearing diaphyseal segments normal walking was possible at 8.5 months on average.

Cited by 205 publications

References 18 publications

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

Masquelet Technique for Reconstruction of Extensive Bone Defect of Tibia after Gunshot Injury in a Child: Case Report

Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect

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