Effects of topical mechanical stability on the formation of Masquelet membrane in a rabbit radial defect model

Xie, Jie; Liu, Donghao; Wang, Haoyi; Long, Haitao; Zhu, Yong; Hu, Yihe; Zeng, Min

doi:10.1038/s41598-020-76112-3

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…IHC showed the greater vascularisation potential of the IM compared with the PM due to the higher‐level expression of VEGF, CD31 and CD34. IM vascularisation has also been demonstrated in other human and animal studies 32,33 …”

Section: Discussionmentioning

confidence: 74%

“…IM vascularisation has also been demonstrated in other human and animal studies. 32,33 Sufficient debridement is a prerequisite for wound coverage, 34 including radical excision of non-viable tissues and those of doubtful viability. The infection of granulation tissue must be avoided as it can result in poor adhesion despite sufficient surgical debridement and other measures during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Management of wounds with exposed bone structures using an induced‐membrane followed by polymethyl methacrylate and second‐stage skin grafting in the elderly with a 3‐year follow‐up

Cai

Hong

Zhang

et al. 2022

International Wound Journal

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The treatment of traumatic wounds with exposed bone or tendons is often challenging. An induced membrane (IM) is used to reconstruct bone defects, as it provides an effective and sufficient blood supply for bone and soft‐tissue reconstruction. This study explored a novel two‐stage strategy for wound management, consisting of initial wound coverage with polymethyl methacrylate (PMMA) and an autologous split‐thickness skin graft under the IM. Fifty inpatients were enrolled from December 2016 to December 2019. Each patient underwent reconstruction according to a two‐stage process. In the first stage, the defect area was thoroughly debrided, and the freshly treated wound was then covered using PMMA cement. After 4‐6 weeks, during the second stage, the PMMA cement was removed to reveal an IM covering the exposed bone and tendon. An autologous split‐thickness skin graft was then performed. Haematoxylin and eosin (H&E) staining and immunohistochemical analysis of vascular endothelial growth factor (VEGF), CD31 and CD34 were used to evaluate the IM and compare it with the normal periosteal membrane (PM). The psychological status and the Lower Extremity Function Scale (LEFS) as well as any complications were recorded at follow‐up. We found that all skin grafts survived and evidenced no necrosis or infection. H&E staining revealed vascularised tissue in the IM, and immunohistochemistry showed a larger number of VEGF‐, CD31‐ and CD34‐positive cells in the IM than in the normal PM. The duration of healing in the group was 5.40 ± 1.32 months with a mean number of debridement procedures of 1.92 ± 0.60. There were two patients with reulceration in the group. The self‐rating anxiety scale scores ranged from 35 to 60 (mean 48.02 ± 8.12). Postoperatively, the LEFS score was 50.10 ± 9.77. Finally, our strategy for the management of a non‐healing wound in the lower extremities, consisting of an IM in combination with skin grafting, was effective, especially in cases in which bony structures were exposed in the elderly. The morbidity rate was low.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Management of wounds with exposed bone structures using an induced‐membrane followed by polymethyl methacrylate and second‐stage skin grafting in the elderly with a 3‐year follow‐up

Cai

Hong

Zhang

et al. 2022

International Wound Journal

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“…Regarding the methods of fixation, 29 studies (62%) used plate and screws, 5 (11%) used an intramedullary nail, 4 (9%) used an external fixator, 1 (2%) used a K-wire, 2 (4%) used a splint only, and 7 (15%) used no fixation at all. Among these, 1 study compared fixation with plate and screws to no fixation, after creating a defect in the radius of rabbits [42] …”

Section: Resultsmentioning

confidence: 99%

“…Among these, 1 study compared fixation with plate and screws to no fixation, after creating a defect in the radius of rabbits. [ 42 ]…”

Section: Resultsmentioning

confidence: 99%

The induced membrane technique in animal models: a systematic review

Sun

Godbout

Hali

et al. 2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: The induced membrane technique (IMT) is a 2-stage surgical approach that has become increasingly popular to manage bone defects. Preclinical investigations have been conducted to better understand and define several aspects of this technique. This review summarizes the literature regarding the IMT performed in animal models and identifies potential future directions. Data Sources: Biosis Citation Index, Ovid Embase, and Ovid MEDLINE databases were searched from inception up to June 23, 2021 for articles related to the IMT. Study Selection: Animal studies involving the use of the IMT for segmental defects in long bones were selected. Only full-length original research articles published in English or French were included. Data Extraction: Two authors extracted the data from the selected studies and a third author verified the accuracy of the information. Data Synthesis: Information concerning the animal model, the surgical procedures, and the outcome measures were recorded for each study and compiled. Conclusions: Forty-seven studies were included in this review. Twenty-nine studies (62%) performed both stages of the technique, but only 8 (17%) reported on radiographic union rates explicitly and 5 (11%) included biomechanical testing. A large proportion of the preclinical literature on the IMT has failed to report on radiographic union as an outcome. While studies reporting membrane properties are valuable, they may not provide information that translates into clinical practice or further clinical research if the ultimate outcome of bony healing is not considered. Future animal studies of the IMT should consider this in their study design.

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“…[14] Our results indicate that the use of external fixation through 2 stages leads to an increased risk of postoperative infection (OR = 8.16, P = .001) and additional surgery (OR = 14.00, P < .001). This means internal fixation may be a preferable method through two stages, although a detailed elucidation of membrane formation in the first stage of IMT [23] and the bio-mechanical environment for each fixation method [24] have yet to be provided. There were several limitations in our study.…”

Section: Discussionmentioning

confidence: 99%

Induced membrane technique for large bone defects

et al. 2022

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Aims:The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates.Materials and methods: A comprehensive, computerized search of PubMed, Embase, and The Cochrane Library was conducted, and articles published from January 1, 1978 to February 1, 2021 were included. Clinical trials matching the following inclusion criteria were included:1. published as a case series, case-controlled studies, or cohort study; 2. IMT was performed for more than 10 cases within the study.Univariate and multivariate logistic regression were performed with random intercepts to determine the association of specific predictor variables with nonunion rate, postoperative infection, the need for additional procedures, and time to union.Results: Seventy eight trials were included in the study with a total of 3840 patients managed with IMT. Mean age was 38.6 (0.8-88) years, mean size of bone defects was 6.4 (0-25) cm primarily distributed in the tibia (n = 1814, 60.9%), and overall union rate was 87.6%. Multivariate analysis showed the odds of nonunion were significantly increased in patients with an interval between two stages from 8 to 12 weeks and ≥12 weeks. Patients with preoperative infection and addition of antibiotic to bone cement during IMT had significantly decreased odds of longer union time, but preoperative infection caused increased odds of additional surgery. External fixation throughout 2 stages had significantly increased odds of postoperative infection and additional surgery.Conclusions: We recommend that the timing of the second stage should be delayed until 6 to 8 weeks after the first stage. Bone cement with antibiotics can control the infection rate and shorten the healing time. Furthermore, there is no need to avoid using internal fixation due to possible concerns about causing postoperative infection.Abbreviations: BMP-2 = bone morphogenetic protein-2, CI = confidence interval, ICBG = iliac crest bone graft, IMT = induced membrane technique, NOS = Newcastle-Ottawa Scale, PMMA = polymethylmethacrylate, RIA = irrigator aspirator.

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Effects of topical mechanical stability on the formation of Masquelet membrane in a rabbit radial defect model

Cited by 7 publications

References 35 publications

Management of wounds with exposed bone structures using an induced‐membrane followed by polymethyl methacrylate and second‐stage skin grafting in the elderly with a 3‐year follow‐up

Management of wounds with exposed bone structures using an induced‐membrane followed by polymethyl methacrylate and second‐stage skin grafting in the elderly with a 3‐year follow‐up

The induced membrane technique in animal models: a systematic review

Induced membrane technique for large bone defects

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