Preliminary Results of the "Capasquelet" Technique for Managing Femoral Bone Defects-Combining a Masquelet Induced Membrane and Capanna Vascularized Fibula with an Allograft.

François Thuau,Alban Fouasson-Chailloux,Alexis Combal,Marc Baud’Huin,Franck Duteille,Pierre-Paul Arrigoni,Vincent Crenn

doi:10.3390/jpm11080774

François Thuau, Alban Fouasson-Chailloux + Show 5 more

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https://doi.org/10.3390/jpm11080774

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Abstract

We describe the preliminary results of a novel two-stage reconstruction technique for extended femoral bone defects using an allograft in accordance with the Capanna technique with an embedded vascularized fibula graft in an induced membrane according to the Masquelet technique. We performed what we refer to as “Capasquelet” surgery in femoral diaphyseal bone loss of at least 10 cm. Four patients were operated on using this technique: two tumors and two traumatic bone defects in a septic context with a minimum follow up of one year. Consolidation on both sides, when achieved, occurred at 5.5 months (4–7), with full weight-bearing at 11 weeks (8–12). The functional scores were satisfactory with an EQ5D of 63.3 (45–75). The time to bone union and early weight-bearing with this combined technique are promising compared to the literature. The osteoinductive role of the induced membrane could play a positive role in the evolution of the graft. Longer follow up and a larger cohort are needed to better assess the implications. Nonetheless, this two-stage technique appears to have ample promise, especially in a septic context or in adjuvant radiotherapy in an oncological context.

Highlights

Critical diaphyseal bone defects remain a surgical challenge, and several treatment methods have been described [1,2,3,4,5,6]
We performed this innovative procedure in critical bone defects of at least 10 cm that were due to the fact of tumor pathology secondary to carcinologic resection or a traumatic event
The osteoinductive role played by the induced membrane can exert a positive impact on the bone healing of the graft, with fast allograft and fibula union, early weight-bearing, and a satisfactory functional score

Summary

Introduction

Critical diaphyseal bone defects remain a surgical challenge, and several treatment methods have been described [1,2,3,4,5,6] (autograft, vascularized fibula, bone transport, diaphyseal endoprosthesis, etc.). We describe a novel two-stage technique for reconstruction of extended femoral bone defects, combining the allograft technique with inlay of a vascularized fibula (i.e., “Capanna technique”) [11] and the induced membrane technique (i.e., “Masquelet technique”) [1,12]. We performed this innovative procedure in critical bone defects of at least 10 cm that were due to the fact of tumor pathology secondary to carcinologic resection or a traumatic event. The “Capasquelet” technique can pool these advantages: the contribution of a living graft through the vascularized fibula, associated with the primary mechanical strength of the allograft in an environment that encourages osteogenesis, and an autologous bone graft at the extremities

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