Masquelet induced membrane technique for treatment of rat chronic osteomyelitis

Cui, Tao; Li, Junpeng; Peng, Zhen; Gao, Qiuming; Fan, Xiaolin; Li, Chuangbing

doi:10.3892/etm.2018.6573

Cited by 8 publications

(17 citation statements)

References 26 publications

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“…As the first and basic stage of treatment process, infection elimination mainly includes segmental bone resection, extensive soft tissue debridement, and postoperative antibiotics application, aiming to remove infected focus radically and provide a satisfying environment for secondary reconstruction. Conventionally the second-stage reconstruction is carried out 6–8 weeks or months later, after the symptoms of infection have completely disappeared and the inflammatory markers have reduced to normal levels [ 6 ], by means of Masquelet technique [ 7 , 8 ], vascularized fibular grafts [ 9 ], cancellous bone grafting [ 10 ] or Ilizarov segmental bone transport [ [11] , [12] , [13] ]. In total, the entire hospital stay for post-traumatic osteomyelitis treatment usually takes several weeks or even months, during which patients have to endure two episodes of invasive operations, regardless of the failure of therapy and sharply increased financial costs.…”

Section: Introductionmentioning

confidence: 99%

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Zhou

Ren

Song

et al. 2021

Journal of Orthopaedic Translation

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Background Treatment of lower limb post-traumatic osteomyelitis used to be a staged process, with radical debridement of bone and soft tissues at first stage, followed by a second-stage limb reconstruction operation to restore the limb integrity. Some studies recently reported that achieving infection eradication and limb reconstruction at single-stage seems to be an effective method for lower limb infection, but a comparative study remains lacking. This study aims to compare the results of radical debridement combined with a first/second-staged osteotomy and bone transport, for the management of lower limb post-traumatic osteomyelitis. Methods From January 2013 to June 2018, a total of 102 patients with lower limb post-traumatic osteomyelitis met the criteria were included for analysis, in which 70 patients received one-stage debridement, antibiotic-loaded implantation, metaphysis osteotomy and bone transport were named as one-stage group, while 32 patients with first-stage debridement and antibiotic-loaded calcium sulfate implantation, second-stage osteotomy and bone transport were devised as two-stage group. The outcomes of hospitalization (hospital stay, costs of treatment, surgical time, antibiotic usage) and follow-up (infection-free, treatment failure, infection recurrence, external fixation index (EFI) and docking site union) between the two groups were retrospectively compared. Results For outcomes of hospitalization, patients in the one-stage group had batter results on hospital stay (18.2 days versus 28.9 days, P < 0.05), surgical time (164.8 min versus 257.4 min, P < 0.05), cost of treatment (¥101726.1 versus ¥126718.8, P < 0.05) and the course of antibiotic usage (10.3 days versus 12.0 days, P < 0.05). During the follow-up, 87.1% (61/70) patients in the one-stage group compared to 93.8% (30/32) patients in the two-stage group achieved infection-free (P > 0.05) without any additional debridement operation. 94.3% (66/70) patients in the one-stage group earned wound healing after the operation, comparing to 96.9% (31/32) patients healed in the two-stage group (P > 0.05). Uncontrolled infection was observed on 4 (5.7%) patients in the one-stage group and 1 (3.1%) patients in the two-stage group (P > 0.05), with a result of three achieved infection free in the one-stage group and one patient suffered from amputation in each group respectively. 5 (7.2%) patients in the one-stage group and 1 (3.2%) patient in the two-stage group encountered with infection recurrence (P > 0.05) and were well-managed with re-debridement and antibiotics usage. Significance was not found between two groups on EFI (74.8 days/cm versus 69.0 days/cm, P > 0.05) and docking site nonunion rate (14.5% versus 18.9%, P > 0.05), indicating that bone transport in different stages played a less essential role on bone generation process. The other complications, such as prolonged aseptic drainage [24.3% (17/70) versus 21.9% (7/32)], re-fractur...

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Section: Introductionmentioning

confidence: 99%

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Zhou

Ren

Song

et al. 2021

Journal of Orthopaedic Translation

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“…TNF‐α levels in male Sprague Dawley rats with S . aureus induced osteomyelitis were higher than rats that underwent a sham procedure 52 . Similar to the effects of treatment on CRP, rats receiving the induced membrane treatment displayed lower TNF‐α levels than the untreated infected group at Days 1, 3, 5, and 7 52 …”

Section: Models Of Injury + Infectionmentioning

confidence: 77%

“…In an osteomyelitis model in male Sprague Dawley rats, levels of CRP were higher in infected rats following soft tissue dissection and injection of S. aureus into the bone marrow cavity, compared to rats receiving the sham procedure (no S. aureus ) 52 . Additionally, rats treated with induced membrane technique (vancomycin‐loaded polymethyl methacrylate bone cement) had lower levels of CRP at Days 1, 3, 5, and 7 posttreatment, compared to the untreated infection group 52 . In a 28‐day study of 26‐week‐old male Sprague Dawley (350–450 g) rats receiving ultra‐highly cross‐linked polyethylene tibial implants and S .…”

Section: Models Of Injury + Infectionmentioning

confidence: 88%

Review of immunological plasma markers for longitudinal analysis of inflammation and infection in rat models

Gautreaux

Tucker

Person

et al. 2022

Journal Orthopaedic Research

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Disease or trauma of orthopedic tissues, including osteomyelitis, osteoporosis, arthritis, and fracture, results in a complex immune response, leading to a change in the concentration and milieu of immunological cells and proteins in the blood. While C-reactive protein levels and white blood cell counts are used to track inflammation and infection clinically, controlled longitudinal studies of disease/injury progression are limited.Thus, the use of clinically-relevant animal models can enable a more in-depth understanding of disease/injury progression and treatment efficacy. Though longitudinal tracking of immunological markers has been performed in rat models of various inflammatory and infectious diseases, currently there is no consensus on which markers are sensitive and reliable for tracking levels of inflammation and/or infection. Here, we discuss the blood markers that are most consistent with other outcome measures of the immune response in the rat, by reviewing their utility for longitudinal tracking of infection and/or inflammation in the following types of models: localized inflammation/arthritis, injury, infection, and injury + infection. While cytokines and acute phase proteins such as haptoglobin, fibrinogen, and α 2 -macroglobulin demonstrate utility for tracking immunological response in many inflammation and infection models, there is likely not a singular superior marker for all rat models. Instead, longitudinal characterization of these models may benefit from evaluation of a collection of cytokines and/or acute phase proteins.Identification of immunological plasma markers indicative of the progression of a pathology will allow for the refinement of animal models for understanding, diagnosing, and treating inflammatory and infectious diseases of orthopedic tissues.

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“…Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis and can be divided into three categories: local infection due to incomplete debridement of an infected open wound, chronic inflammation developed from acute osteomyelitis and iatrogenic infection [1]. Osteomyelitis may lead to fracture nonunions; there is strong evidence that infection delays the fracture healing process.…”

Section: Introductionmentioning

confidence: 99%

Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions

Guzzini

Arioli

Rugiero

et al. 2020

Handchir Mikrochir Plast Chir.

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Backgrounds Chronic osteomyelitis is a major challenge in orthopaedic surgery; it is the result of open fracture, periprosthetic infection and septic arthritis. Osteomyelitis leads to fracture nonunion. The treatment of bone infection and infected nonunion consists primarily of the complete removal of infected and avascular bone and soft tissue from the surgical site, followed by local and systemic pathogen-specific antibiotic therapy and temporary stabilisation, but may lead to massive skeletal and soft tissue defects. The use of free or pedicled vascularised bone transfers and callus distraction techniques (bone transport) has been recommended for large bone defects. The aim of this study is to evaluate the results of patients affected by infected non-unions of the lower limbs, treated with a corticoperiosteal flap from the medial femoral condyle and to investigate the donor site morbidity of this flap. Materials and methods The patients were 11 males (average age of 45.6 years), who presented a nonunion of the tibial diaphysis in 7 cases and non-union of femoral diaphysis in 4 cases, treated with free or pedicled corticoperiosteal flap. In all patients, surgical debridement was performed before the flap of infected bone and soft tissues that would not contribute to wound healing. Clinical and radiographic evaluations of the recipient site were performed. Preoperative and postoperative X-ray and MRI scans after the 3-year follow-up of the donor site were performed, in order to observe possible bone restoration and any complications. Results The patients reported complete clinical and radiographic bone healing in 90.9 % of cases. As regards donor site, there were no differences between the medial femoral donor condyle compared to the contralateral site, due to complete regeneration of donor site bone. MRI investigation showed complete restoration of the donor site with vascularised bone in all patients. Conclusions Our results suggest that the use of bone flaps for the treatment of infected non-unions is an effective procedure, that must be performed after accurate debridement of the non-union site. The corticoperiosteal flap seems to have few morbidities on the donor site and a high percentage of successful bone healing.

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Masquelet induced membrane technique for treatment of rat chronic osteomyelitis

Cited by 8 publications

References 26 publications

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

One-stage debridement and bone transport versus first-stage debridement and second-stage bone transport for the management of lower limb post-traumatic osteomyelitis

Review of immunological plasma markers for longitudinal analysis of inflammation and infection in rat models

Donorsite defect of medial femoral condyle corticoperiostal flap in the treatment of lower limb infected nonunions

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