Because of its simplicity, reliability, and replicability, the Masquelet induced membrane technique (IMT) has become one of the preferred methods for critical bone defect reconstruction in extremities. Although it is now used worldwide, few studies have been published about IMT in military practice. Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury, early wound infection, and even delayed management in austere conditions. Based on our clinical expertise, recent research, and a literature analysis, this narrative review provides an overview of the IMT application to combat-related bone defects. It presents technical specificities and future developments aiming to optimize IMT outcomes, including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
PurposeWe want to evaluate the feasibility of transferring a motor branch of the the anterior tibial muscle (ATM) on the extensor digitorum longus (EDL) in order to evaluate this procedure in patients with spastic Equino Varus Foot (EVF) following a post-stroke hemiplegia.MethodsTen cadaveric dissections from five fresh frozen human cadavers were performed in order to establish the anatomic feasibility of transferring a motor branch of the deep peroneal nerve with is usually destinated to the Anterior Tibialis Muscle (ATM) onto the branch of the Extensor Digitorum Longus (EDL), to manage spastic equinovarus foot (SEF). Results Six cases (60%) presented 3 branches detonated to the ATM, one case (10%) presented 5 branches, 3 cases (30%) had 4 branches. In all specimens, the coaptation between the motor branch to the anterior tibial muscle, referred as the ‘effector’ branch, and the branch of the EDL ‘receiver’ branch was feasible without tension and did not require any intra-neural dissection.ConclusionThis anatomical study confirms the feasibility of transferring a motor branch from the ATM to the EDL to correct a spastic EVF.
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