Induced membrane maintains its osteogenic properties even when the second stage of Masquelet’s technique is performed later

Gindraux, Florelle; Loisel, François; Bourgeois, Michael; Oudina, Karim; Melin, Martine; Billy, B. de; Sergent, P; Leclerc, Grégoire; Petite, Hervé; Auber, F.; Obert, L.; Pluvy, I.

doi:10.1007/s00068-019-01184-4

Cited by 38 publications

(53 citation statements)

References 33 publications

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“…On the other hand, the membrane acts as a barrier to prevent surrounding soft tissue from growing into the defect and resorption of the implanted graft [6,32,33]. The osteogenic activity peaks between two and four weeks and mostly subsides after six weeks in rats, whereas in humans, a constant pro-osteogenic potential of the induced membrane could be seen over a period of up to 15 months [34]. However, the influence of vascularization of the induced membrane on bone regeneration seems to decline with increasing healing time [6,7,35].…”

Section: Discussionmentioning

confidence: 99%

Introduction of a New Surgical Method to Improve Bone Healing in a Large Bone Defect by Replacement of the Induced Membrane by a Human Decellularized Dermis Repopulated with Bone Marrow Mononuclear Cells in Rat

et al. 2020

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The Masquelet technique for the treatment of large bone defects is a two-stage procedure based on an induced membrane. We eliminate the first surgical step by using a decellularized dermal skin graft (Epiflex®) populated with bone marrow mononuclear cells (BMC), as a replacement for the induced membrane. The aim of this study was to demonstrate the feasibility of this technology and provide evidence of equivalent bone healing in comparison to the induced membrane-technique. Therefore, 112 male Sprague–Dawley rats were allocated in six groups and received a 10 mm femoral defect. Defects were treated with either the induced membrane or decellularized dermis, with or without the addition of BMC. Defects were then filled with a scaffold (β-TCP), with or without BMC. After a healing time of eight weeks, femurs were taken for histological, radiological and biomechanical analysis. Defects treated with Epiflex® showed increased mineralization and bone formation predominantly in the transplanted dermis surrounding the defect. No significant decrease of biomechanical properties was found. Vascularization of the defect could be enhanced by addition of BMC. Considering the dramatic reduction of a patient’s burden by the reduced surgical stress and shortened time of treatment, this technique could have a great impact on clinical practice.

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Section: Discussionmentioning

confidence: 99%

Introduction of a New Surgical Method to Improve Bone Healing in a Large Bone Defect by Replacement of the Induced Membrane by a Human Decellularized Dermis Repopulated with Bone Marrow Mononuclear Cells in Rat

et al. 2020

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“…We found no signi cant correlation between vascularity and the duration of cement placement. Recently, Gindraux et al have reported that bone healing is not disturbed when the second surgical stage of Masquelet's technique is performed at a later time point [19]. The median waiting period between the rst and second surgical stage ranged from 5.8 to 14.7 months.…”

Section: Discussionmentioning

confidence: 99%

“…Rich vascularity may induce bone formation inside the IM. Rich vascularity along with osteogenic and osteoinductive activity [10,11,14,15,19,22] are key components of IM. Although the relationship and balance between vascularity and osteogenic/osteoinductive activity is not clear, our ndings may provide clues to obtain a better understanding of this relationship.…”

Section: Discussionmentioning

confidence: 99%

Histological Analysis of Induced Membranes in Patients Whose Bone Defects Were Treated With the Masquelet Technique to Identify Factors Affecting the Vascularity of Induced Membranes

Niikura

Jimbo

Komatsu

et al. 2021

Preprint

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BackgroundRich vascularity of the induced membrane (IM) is important for Masquelet reconstruction surgery. The factors affecting IM vascularity are not completely understood. This study aimed to investigate these factors using histological samples of human IMs.MethodsWe retrospectively evaluated 36 patients whose bone defects were treated using the Masquelet technique. Two clinical pathologists analyzed histological sections of IM pieces (1-cm2). The number of blood vessels per 1 mm2 was counted and compared among men and women, femur or tibia, with and without free flap surgery, antibiotic impregnation to the cement, osteogenesis inside the membrane, smoking, and diabetes mellitus. The number of blood vessels within the same patient was compared among different time points. Correlation analysis was performed among blood vessel numbers and patient age, duration of cement spacer placement, and histological grading scales (inflammation, foreign body reaction, and fibrosis).ResultsIM formation with rich vascularity and some inflammation, foreign body reaction, and fibrosis was histologically confirmed in all patients. We found 37.4 ± 19.1 blood vessels per 1 mm2. Blood vessel numbers were significantly lower in patients with than in those without free flap surgery. Blood vessel numbers were higher in patients with osteogenesis inside the IM. No significant correlations were found in any of the analyses.ConclusionSex, patient age, smoking, diabetes mellitus, femur or tibia, duration of cement spacer placement, and antibiotic impregnation to the cement did not affect IM vascularization. IM vascularization was reduced in patients with than in those without free flap surgery.

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“…Indeed, findings presented here were based upon a small cohort of membranes with both short and long maturation times (6 to 40 weeks old) and derived from either upper or lower limb fractures that were stabilized by various types of fixation. A recent work from Gindraux et al [42] suggested that IMs maintained their osteogenic properties even when the second stage of the surgery is delayed. Besides Gindraux's report, the impact of the risk factors on the IM properties are wholly underexplored, even though risk factors are likely to influence important properties of the IMs, such as vascularization.…”

Section: Discussionmentioning

confidence: 99%

Towards Understanding Therapeutic Failures in Masquelet Surgery: First Evidence that Defective Induced Membrane Properties are Associated with Clinical Failures

Durand¹,

Barbier²,

Laurent

et al. 2020

JCM

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The two-stage Masquelet induced-membrane technique (IMT) consists of cement spacer-driven membrane induction followed by an autologous cancellous bone implantation in this membrane to promote large bone defect repairs. For the first time, this study aims at correlating IMT failures with physiological alterations of the induced membrane (IM) in patients. For this purpose, we compared various histological, immunohistochemical and gene expression parameters obtained from IM collected in patients categorized lately as successfully (Responders; n = 8) or unsuccessfully (Non-responders; n = 3) treated with the Masquelet technique (6 month clinical and radiologic post-surgery follow-up). While angiogenesis or macrophage distribution pattern remained unmodified in non-responder IM as compared to responder IM, we evidenced an absence of mesenchymal stem cells and reduced density of fibroblast-like cells in non-responder IM. Furthermore, non-responder IM exhibited altered extracellular matrix (ECM) remodeling parameters such as a lower expression ratio of metalloproteinase-9 (MMP-9)/tissue inhibitor of metalloproteinases (TIMP-1) mRNA as well as an important collagen overexpression as shown by picrosirius red staining. In summary, this study is the first to report evidence that IMT failure can be related to defective IM properties while underlining the importance of ECM remodeling parameters, particularly the MMP-9/TIMP-1 gene expression ratio, as early predictive biomarkers of the IMT outcome regardless of the type of bone, fracture or patient characteristics.

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Induced membrane maintains its osteogenic properties even when the second stage of Masquelet’s technique is performed later

Cited by 38 publications

References 33 publications

Introduction of a New Surgical Method to Improve Bone Healing in a Large Bone Defect by Replacement of the Induced Membrane by a Human Decellularized Dermis Repopulated with Bone Marrow Mononuclear Cells in Rat

Introduction of a New Surgical Method to Improve Bone Healing in a Large Bone Defect by Replacement of the Induced Membrane by a Human Decellularized Dermis Repopulated with Bone Marrow Mononuclear Cells in Rat

Histological Analysis of Induced Membranes in Patients Whose Bone Defects Were Treated With the Masquelet Technique to Identify Factors Affecting the Vascularity of Induced Membranes

Towards Understanding Therapeutic Failures in Masquelet Surgery: First Evidence that Defective Induced Membrane Properties are Associated with Clinical Failures

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