Masquelet Induced Membrane Technique Helps Fill Many Bone Voids.

Abstract

The concept behind the “induced membrane technique” (aka the Masquelet procedure) for healing large, critical-size bone defects is simple and sound. In stage 1, following adequate wound debridement, surgeons place an interpositional cement spacer in the defect gap that firmly articulates with the bone ends, usually aided by some form of fixation. Over a minimum period of approximately 6 to 8 weeks, the body naturally forms a synovial-like membrane around the spacer. The membrane’s inner layer of epithelium secretes vascular and osteoconductive factors, and the outer fibrous layer serves as a sturdy mechanical envelope. In stage 2, the spacer is carefully removed, and the preserved defect-spanning membrane is filled with bone graft. The inner layer of the membrane promotes revascularization and differentiation of the graft, and the outer layer prevents resorption. Since its introduction in the late 20th century, the induced membrane technique has been lauded for its bone-reconstruction advantages over alternatives such as distraction osteogenesis and vascularized bone. The cases presented in this month’s “Case Connections” demonstrate that the technique can work with a variety of bone-defect shapes, sizes, and locations. The August 10, 2016, edition of JBJS Case Connector features a report by Felden et al. that describes 3 cases of chronic post-infection osteomyelitis in children in whom large diaphyseal defects were successfully treated with the Masquelet induced membrane technique. In the first case, a 7-year-old boy with osteolysis of the right humerus was referred to the authors. There were no local signs of active infection, but the affected arm had a length discrepancy of 6 cm. After resecting 12 cm of bone, surgeons filled the defect with a cement spacer, which was stabilized with 2 intramedullary Kirschner wires (Fig. 1). The patient was managed with a shoulder spica cast for 45 days. During the second stage …