Very long-term results of post-traumatic bone defect reconstruction by the induced membrane technique

Masquelet, A. C.; Kishi, Taka; Benko, Pierre Etienne

doi:10.1016/j.otsr.2018.11.012

Cited by 66 publications

(42 citation statements)

References 16 publications

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“…However, pin tract infection is the major complication of external fixation, which can decrease the stability [3]. When the infected site is close to the joint, transarticular fixation leads to joint stiffness [15], which is not conducive to the recovery of joint function. External fixation is bulky, which affects patients' ordinary life [16].…”

Section: Discussionmentioning

confidence: 99%

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Jia

Xiao-hua

et al. 2020

J Orthop Surg Res

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Background: The induced membrane technique has achieved good clinical results in the treatment of infected bone defects, and external fixation is the main method, but it causes inconvenience and complications in patients. In this study, our objective was to investigate the outcomes of using an antibiotic cement-coated locking plate as a temporary internal fixation in the first stage of the surgical induced membrane technique for treating extremities with infected bone defects. Methods: We retrospectively analysed patients with lower extremity infected bone defects in our department between January 2013 and December 2017. All patients were treated with the induced membrane technique. In the first stage, the defects were stabilized with an antibiotic cement-coated locking plate as a temporary fixation after debridement, and polymethyl methacrylate cement was implanted to induce the formation of a membrane. In the second stage, bone grafting rebuilt the bone defects after infection control, and the temporary fixation was changed to a stronger fixation. Results: A total of 183 patients were enrolled, with an average follow-up duration of 32.0 (12-66) months. There were 154 males and 29 females with an average age of 42.8 (10-68) years. The infection sites included 81 femurs, 100 tibias and 2 fibulas. After the first stage of treatment (infection control), 16 (8.7%) patients had recurrence of infection. In terms of the incidence of complications, 4 patients had poor wound healing, 2 patients had fixation failure and 1 patient had femoral fracture due to a fall. After the second stage of treatment (bone reconstruction), there were 24 (13.1%) recurrences of infection, with a mean time of 9.9 months (range 0.5 to 36). Among them, 18 patients underwent bone grafting after re-debridement, 6 received permanent placement of antibiotic bone cement after debridement and 2 patients refused further treatment and chose amputation. Bone healing was achieved in 175 (95.9%) patients at the last follow-up, and the average time to bone union was 5.4 (4-12) months. Conclusions: Antibiotic cement-coated locking plates have good clinical effects in the control of bone infection, but attention must be paid to the possible difficulty of skin coverage when applied in calves.

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Section: Discussionmentioning

confidence: 99%

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Jia

Xiao-hua

et al. 2020

J Orthop Surg Res

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“…This elongation nail, which was not robust enough for bone defect reconstruction, should have been changed since the IMT was decided. A very stable degree of fixation is indeed required to promote membrane induction and graft revascularization [2,12,15]. Clinical observations and the assumption of mechanical failure were supported by the P2 membrane histological examination.…”

Section: Case Reports In Orthopedicsmentioning

confidence: 88%

“…Moreover, the graft consistency during the first revision clearly indicated that its revascularization by the membrane had failed. The P1 IM failure can be explained by the extended 10-month induction period between the two stages, as the recommended interval ranges from four to six weeks [3,12]. Recent studies found that IM biological properties decrease markedly with time and confirmed that bone grafting should not be delayed beyond the recommended period [2,11,13,14].…”

Section: Case Reports In Orthopedicsmentioning

confidence: 99%

Repeated Induced-Membrane Technique Failure without Infection: A Series of Three Consecutive Procedures Performed for a Single Femur Defect

Laurent

Durand²,

Demoures

et al. 2020

Case Reports in Orthopedics

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A 40-year-old male was treated using the induced-membrane technique (IMT) for a noninfected, 9 cm long femoral bone defect complicating a lengthening procedure. The interesting case feature lies in the three consecutive IMT procedures that were necessary to achieve complete bone repair in this unusual clinical situation. The first procedure failed because of the lack of graft revascularization likely related to an induced-membrane (IM) alteration demonstrated by histological observations. The second IMT procedure led to partial graft integration interrupted by the elongation nail breakage. At last, the third procedure fully succeeded after nail exchange and iterative iliac bone grafting. Complete bone union was achieved with a poor functional recovery one year after the last procedure and four years following the first cement spacer implantation. By means of clinical and histological observations, we demonstrated that the first and the second IMT failures had two distinct origins, namely, biological and mechanical causes, respectively. Although simple, a successful IMT procedure is not so easy to complete.

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“…The induced membrane technique, often eponymously referred to as the Masquelet technique, is a twostage technique involving placement of a foreign body within the defect that results in a biologicallyactive membrane around the defect, which can then provide biology for subsequent bone formation using graft [14,15] . The first stage entails radical debridement and skeletal stabilization [15,16] . A spacer, typically made from polymethylmethacrylate cement, is placed.…”

Section: Induced Membrane Techniquesmentioning

confidence: 99%

Review of soft tissue coverage options in distraction osteogenesis of the extremity

Stoneburner¹,

Azadgoli²,

Howell³

et al. 2020

PAR

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Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity. Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted. Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2%) and acute trauma (41.8%). Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0%) or rotational flaps (12.0%) were used, with muscle flaps (96.7%) being most common. Most extremities received free latissimus dorsi or rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and reoperations were not uncommon (up to 30%), 98.8% of patients on average were ultimately weight bearing and all articles reported > 91% success rate. Additionally, the rates of any complication were not statistically different between "fix and flap" protocol and flap or frame first. Lastly, a three-patient case series is presented. Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior, and decision should be made on a case by case basis between the surgeon and the patient.

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Very long-term results of post-traumatic bone defect reconstruction by the induced membrane technique

Cited by 66 publications

References 16 publications

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization

Repeated Induced-Membrane Technique Failure without Infection: A Series of Three Consecutive Procedures Performed for a Single Femur Defect

Review of soft tissue coverage options in distraction osteogenesis of the extremity

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