Induced Membranes-A Staged Technique of Bone-Grafting for Segmental Bone Loss

Abstract

Diaphyseal defects too long to be bridged by cancellous bone graft require complex reconstruction. Distraction osteogenesis requires specialized equipment, has a steep learning curve, and is plagued by attendant pin-site complications and nonunion1,2. Vascularized bone, such as from the fibula, requires microsurgical anastomoses (free), or is limited by pedicle length (pedicled), and has attendant donor-site morbidity (both free and pedicled)1,3. The French technique of bone-grafting within induced membranes, otherwise known as the Masquelet technique, offers a viable alternative with minimal complications4,5. In this technique, a cement spacer is placed in a posttraumatic bone defect. Its presence serves a twofold function of preventing fibrous ingrowth into the bone gap, and inducing the formation of specialized tissue or so-called induced membranes around it. Bone graft placed within this tube of induced membranes incorporates into functioning bone. We present the case of a patient with diaphyseal bone loss and the case of a patient with epimetaphyseal bone loss, both with ongoing bacterial contamination, successfully treated by this procedure. Both patients were informed that data concerning the case would be submitted for publication, and they consented. Case 1. A twenty-year-old woman was struck by an automobile while crossing the road. She sustained an open (Gustilo-IIIB) diaphyseal fracture of the left tibia (AO-OTA 42-C3) with marked loss of the soft-tissue envelope over the medial, anterior, and posterior aspects of the leg6. The wound was debrided on admission, and immobilization was achieved with an external fixator (Fig. 1). Two additional surgical debridements were necessary to ensure complete removal of extensive road debris contamination and to prepare the wound bed for future soft-tissue coverage. The defect was eventually covered with a vascularized rectus abdominis muscle flap six weeks later. Her recovery was …