Post-Traumatic Bone and Soft-Tissue Defects Treated with the Masquelet Induced-Membrane Technique: A Review of Technique and Outcomes
Abstract
Introduction: Post-traumatic bone and soft tissue defects can be managed by combining Masquelet induced membrane technique (MIMT) with local flaps. Compared to Ilizarov’s technique, this technique heals independent of defect length with no or short frame time. In this case series, we describe this technique’s critical steps and reviewed the outcomes.
Materials and methods: This is a single surgeon retrospective review, between July 2021 and June 2023. Two stages MIMT were performed on nine cases of bone defect with or without soft tissue defect, either due to index trauma or fracture related infection. In first stage, bone was debrided and stabilised with various fixation techniques followed by cementation, local flaps applied if indicated. Once soft tissue equilibrium achieved, second stage replaced cement with quantified amount of bone grafts, and bone fixation was revised accordingly.
Results: Bone defects length ranged from 4 to 9cm while bone grafts volume ranged from 17 to 41cc. Stage 1 fixation choices include Ilizarov or conventional external fixator, intercalary cemented intramedullary rod with Ilizarov hinges, plate and nail, while stage 2 includes plate and nail as definitive fixation. Time between two stages ranges from one to five months, bone union achieved between four and nine months. Out of nine cases, eight had excellent ASAMI bony outcome, six had excellent ASAMI functional outcome.
Conclusion: Bone grafts quantification allows appropriate autologous to total graft ratio, avoids excessive or inadequate bone graft harvesting. Different bone fixation choices have their own advantages. MIMT with local flap is a strategic combination.
Abstract | Reference
