Induced Membrane Technique For Treatment Research Articles

Comparison of artificial dermis Lando® versus Pelnac® combined with induced membrane technique in treatment of composite trauma in rabbit bilateral femurs

Objective To compare 2 kinds of artificial dermis Lando® versus Pelnac® combined with induced membrane technique in the treatment of composite trauma in rabbit bilateral femurs. Methods Twenty-seven male rabbits, weighing from 1.92 kg to 2.21 kg (average, 2.04 kg), were used in the experiments. After models of composite trauma were created in the bilateral femurs of all the rabbits, the bilateral femurs of 9 random rabbits were subjected to the treatment of artificial dermis Lando® plus induced membrane (Lando® group), the bilateral femurs of another 9 random rabbits to the treatment of artificial dermis Pelnac® plus induced membrane (Pelnac® group), the left femur of the remaining 9 rabbits to the treatment of induced membrane (control group) and the right femur of the remaining 9 rabbits to no treatment (sham operation group). Three rabbits from each group (the same for the control and sham operation groups) were randomly sacrificed at 2, 4 and 6 weeks after operation. Samples from the operation sites were taken for gross observation of the induced membrane and observation of the microstructure of the membrane by conventional hematoxylin-eosin staining. In addition, the microvessel density (MVD) was counted under microscopy taking CD34 immunohistochemistry as the standard. The data were statistically analyzed. Results The collagen sponge layer was completely degraded 2 weeks after operation in the Lando® group but not in the Pelnac® group. The MVD [(0.90±0.55)/HPF] in the Lando® group was significantly greater than that in the Pelnac® group [(0.28±0.13)/HPF] (P 0.05). At 6 weeks postoperatively, the MVD [(4.97±0.76)/HPF] in the Lando® group was significantly smaller than that in the Pelnac® group [(7.06±1.03)/HPF] (P 0.05). The MVD at 4 and 6 weeks after operation in the control and the sham operation groups were all significantly different from those in the Lando® and the Pelnac® groups (P<0.05). Conclusions In the treatment of composite trauma in rabbits, the 2 kinds of artificial dermis combined with the induction membrane technique can lead to formation of induced membrane structure, providing a new alternative treatment for patients with bone and soft tissue defects caused by various causes in the clinic. The Lando® artificial dermis may accelerate the vascularization of induced membrane at 2 weeks while the Pelnac® may accelerate the vascularization at 4 and 6 weeks. Key words: Femur; Dermis; Soft tissue injuries; Artificial dermis; Bone defect

Clinical outcomes of induced membrane technique in treatment of traumatic segmental bone defects

Objective To evaluate the clinical outcomes of induced membrane technique in the treat-ment of traumatic segmental bone defects. Methods From May 2011 to January 2016, we treated 10 pa-tients with traumatic segmental bone defect of the lower limb. They were 7 men and 3 women, with an average age of 41.6 years (from 18 to 61 years. The bone defects involved 8 tibias and 2 femurs; the mean length of the bone defects was 5.1 cm (from 2 to 15 cm). All the segmental bone defects were teated by induced membrane technique. At the first stage, the bone defects were filled with antibiotic-impregnated cement spacer after thor-ough debridement, the limb was fixated with external fixtor, and soft tissue repair was performed in 5 patients. On average all the patients received emergency treatment at the first stage 8.1 hours (from 4 to 13 hours) after trauma. At the second stage, after the cement was removed, the bone defects were filled with cancellous auto-grafts. An allograft was used when the autograft was not adequate enough. The external fixtor was exchanged by internal fixation in one patient according to his soft tissue condition and will; the exteranl fixation was retained in the other 9 patients. Results The average follow-up was 2.8 years (from 1.0 to 5.5 years). Bone healing was achieved in 9 patients after an average of 7.1 months (from 5 to 9 months), and nonunion happened in one patient whose bone graft had been not sufficient enough. Stress fracture occurred in one patient 7 months after bone healing, but it responded to conservative management. One patient reported numbness on the anterolateral thigh of the donor site. Pin tract infection occurred in 3 patients. Follow-ups revealed no limb length discrepancy or deep infection. Conclusion Induced membrane technique is a simple and reliable technique for the treatment of traumatic segmental bone defects. Key words: Bone defects; Induced membrane technique; Treatment outcome

En bloc resection combined with induced membrane technique for treatment of Cierny-Mader type IV posttraumatic long bone infection

Objective To investigate the results of Cierny-Mader type Ⅳ posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique. Methods A retrospective case series analysis was made on 36 patients with posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique from January 2013 to January 2015. There were 30 male and 6 female patients between 21 and 68 years (mean, 41 years). Infection control, bone union, function activity and complications were detected after operation. Results After debridement in the first stage, a segmental bone defect of 5.5 cm in length (range, 2-10.9 cm) was seen in all patients. Seven patients needed a local flap transfer to cover the wound and five patients had a second debridement. Mean duration of systemic antibiotic use was 2 weeks (range, 1-6 weeks) and mean time interval of second-stage bone grafting was 12 weeks after debridement (range, 6-36 weeks). Mean follow-up was 29.5 months (range, 24-45 months). One patient had recurrence and was cured with radical debridement and a permanent acrylic spacers insertion, with the cure rate of bone infection of 97% (35/36). All patients achieved bone union with a mean duration of 5.9 months (range, 4-8 months), and were able to walk independently. Thirty patients returned to work or pre-operative physical labor. No pain and re-fracture occurred. Six patients had adjacent joint stiffness. Conclusion En bloc resection combined with induced membrane technique is associated with radical debridement, decreased recurrence rate and limb salvage, indicating a simple and effective method for Cierny-Mader type IV posttraumatic long bone infection. Key words: Osteomyelitis; Fractures, bone; Induced membrane technique

Bone transport technique versus induced membrane technique for treatment of infected bone nonunion

Objective To compare the clinical outcomes of bone transport technique versus induced membrane technique for treatment of infected bone nonunion. Methods A retrospective study was made on 46 cases of infected bone nonunion admitted from April 2011 to December 2014. They were 33 males and 13 females, aged from 12 to 68 years (mean, 45.3 years), involving 40 tibial and 6 femoral fractures. Bone transport technique was used in 37 cases while 9 cases were treated with induced membrane technique. Fracture union and complications were recorded. The function of the affected limb was evaluated at the final follow-up using Johner-Wruhs criteria. Results The 46 cases were followed up for 9 to 18 months (mean, 14 months). In the bone transport group, bone union was achieved after a mean duration of 6.5 months (range, from 4 to 11 months) without complications like wound infection or neurovascular lesions. In the induced membrane group, bone union was achieved after a mean duration of 5.8 months (range, from 4 to 11 months) and there was one case of reinfection. According to the Johner-Wruhs score system, 34 cases were rated as excellent, 9 as good and 3 as fair, with a total excellent and good rate of 93.5%. Bone transport technique led to 28 excellent, 4 good and one fair cases in the patients with tibial nonunion,and one excellent, 2 good and one fair cases in the patients with femoral nonunion. Induced membrane technique led to 3 excellent, 3 good and one fair cases in the patients with tibial nonunion,and 2 excellent cases in the patients with femoral nonunion. Conclusions Both bone transport technique and induced membrane technique are effective for infected bone nonunion. Bone transport technique may be preferred for tibial infected nonunion while induced membrane technique preferred for femoral infected nonunion. Key words: Tibia; Femur; Fractures, nonuion; Bone grafting

Analysis of therapeutic effect of induced membrane technique for treatment of bone defect

Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect. Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females; aged 13-69, average 38.5; infectious bone defect in 16 cases and non-infectious bone defect in 4 cases. Record the complications, evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method, respectively, and grade the range of movement (ROM) of adjacent joints by authors’s method. Results In the first stage of surgery, 1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap, while others had no infection or recurrence of infection. In the second stage of surgery, 3 cases had induced membrane damage and defect. All were followed-up from 12 to 50 months (average 19.7 months); all the bone defects healed, the clinical healing time was 3.0 to 7.0 months (average 4.7 months). The healing time in the 3 cases with induced membrane damage and defect (average 6.0 months) was longer than that in patients without induced membrane damage and defect(average 4.6 months). 1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery, for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery, in whom the infection was controlled by the conservative treatment, the others had no infection or recurrence of infection, no broken of fixators noted; at the last follow-up, all the bone defect healing graded excellent, the functional recovery of the adjacent joints graded: excellent in 8 cases, good in 10 cases, and fair in 2 cases (the excellent and good rate was 90%), the ROM of the adjacent joints graded: excellent and good in 8 cases, respectively, fair and poor in 2 cases, respectively (the excellent and good rate was 80%). Conclusion Induced membrane technique has advantages of simple surgery, faster healing of bone defect, no correlation between the healing time and the length of bone defect, fewer complications, etc, but in clinical application, the operators must understand the therapy principle and pay attention to the influencing factors and technical points so as to avoid operation errors, reduce complications and improve therapeutic effect. Key words: Extremities; Wounds and injuries; Infection; Bone Cements

Induced membrane technique for treatment of post-traumatic tibial osteomyelitis

Purpose To investigate the clinical outcome of induced membrane technique for treatment of post-traumatic tibial osteomyelitis. Methods A retrospective analysis was made on 17 cases of post-traumatic tibial osteomyelitis admitted from August 2011 to October 2012. There were 13 males and 4 females aged 19-67 years (mean, 40.9 years). Mean length of bone defect was 6.7 cm (range, 2.0-18.5 cm). Surgical treatments were performed including phase Ⅰ surgical debridement and antibiotics-loaded bone cement impregnation to induce a membrane and phase Ⅱ bone defect reconstruction by intramembranous bone grafting. Clinical effect of the treatment was evaluated. Results Bone healing was detected at the 27-month follow-up (range, 24-32 months). Radiographic healing was obtained 4-6 months after operation. Two cases of recurrent infection were noted after phase Ⅰ surgery and had another debridement. External fixator proximal pin track infection occurred in one case and infection was controlled by hardware removal and dressing change. There was one case of metal rejection, two function disorders, one clubfoot, and one ankle stiffness. Conclusion Induced membrane technique is effective in the treatment of post-traumatic tibial osteomyelitis, especially in lone bone defect reconstruction, but limb functional complications are worth consideration during treatment. Key words: Osteomyelitis; Tibial fractures; Induced membrane technique