Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane

Uzel, A.-P.; Lemonne, F.; Casoli, Vincent

doi:10.1016/j.otsr.2009.10.017

Cited by 45 publications

(25 citation statements)

References 23 publications

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“…Our results are encouraging and comparable to other studies which used the same technique of transport over induced membrane in management of infected nonunion of the tibia [21][22]. In contrary to other studies, our protocol highlights the role of using NPWT following debridement of infected nonunion and the use of structural cement-spacer support in the latency period before embarking on tissue reconstruction.…”

Section: Discussionsupporting

confidence: 81%

Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia

El-Rosasy¹,

Mahmoud²,

El-Gebaly³

et al. 2019

International Journal of Orthoplastic Surgery

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Infected non-union of the tibia represents a major challenge to orthopaedic surgeons. Wide resection of infected tissues decreases the recurrence rate of infection in post-osteomyelitis reconstruction. Such radical debridement results in bone and soft tissue defects making the challenge more difficult with creation of a dead space. Elimination of the dead space is a necessity using antibiotic-impregnated cement as a staged technique for further reconstruction of bone and soft tissue. The objective of this series is to assess the efficacy of our integrated protocol for management of infected non-union of the tibia. This prospective study included 23 patients with infected non-union of the tibia with medullary contamination managed by staged debridement and insertion of antibiotic-impregnated cement spacer with later distraction histogenesis using Ilizarov frame for bone and soft tissue reconstruction. The mean age of the patients was 24 years (19 to 52). The mean size of the defect after debridement was 6 cm (range 4-10 cm). The average follow up period was 28 months (range 16-36 months). Successful reconstruction with no recurrence of infection was achieved in all cases (100%) without the need for bone or soft tissue grafts. External fixator index ranged from 35 to 60 days/cm (average 45 days/cm). The functional results were satisfactory in 20 cases (86.9%) and unsatisfactory in 3 cases (13.1%) due to residual leg length discrepancy, joint stiffness, and persistent pain. The proposed staged protocol represents a valid option for successful bone and soft tissue reconstruction and elimination of the infection without the need of bone grafting nor soft tissue procedures.

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Section: Discussionsupporting

confidence: 81%

Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia

El-Rosasy¹,

Mahmoud²,

El-Gebaly³

et al. 2019

International Journal of Orthoplastic Surgery

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“…Group B: the mean consolidation time was 323 days (range 187-559 days). Soft tissue interposition at the docking site was seen three times before surgical docking [11,18,24] (Fig. 2), and a false aneurism of the peroneal artery was seen after one of the surgical docking site procedures (this was treated by embolisation).…”

Section: Resultsmentioning

confidence: 99%

Clinical reliability of closed techniques and comparison with open strategies to achieve union at the docking site

Lovisetti

Sala

Miller

et al. 2011

International Orthopaedics (SICOT)

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Purpose This retrospective review follows 31 tibial nonunions to compare union at the docking site using closed versus open strategies. In this cohort of patients, all but five were infected nonunions. Methods Thirteen patients initially treated with single compression were compared with 18 patients treated by open revision of the docking site. In the single compression group, an average of 6.5 cm of bone was resected and index lengthening was 2.04. In the open revision group, a mean of 9.4 cm was resected and the index lengthening was 1.73.Results Consolidation at the docking site occurred in all subjects in both groups. There was no statistical difference between the two groups. Conclusive evidence of superiority of one modality of treatment over the other cannot be drawn from our data. Conclusions The simple compression procedure requires less invasive surgery and is probably less demanding and more cost-effective in short transports.

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“…Confirming data obtained in sheep (Viateau et al ., ) and rabbits (Viateau et al ., ), the present results indicate that the membrane consists of a dense collagen network organized parallel to the PMMA. In humans, an induced membrane has been shown to be calcified even before grafting (Uzel et al ., ), which may indicate that the membrane is able to promote both graft osteointegration and mineralization. Confirming this hypothesis, the membranes induced in the model used in the present study showed islets of calcification by the third week after PMMA insertion.…”

Section: Discussionmentioning

confidence: 97%

Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique

Gouron

Petit

Boudot

et al. 2014

J Tissue Eng Regen Med

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In 2000, Masquelet reported a long bone reconstruction technique using an induced membrane formed around a polymethylmethacrylate (PMMA) spacer placed in the defect with appropriate stabilization followed by secondary bone graft after PMMA removal. This reconstruction procedure allows rapid and safe bone reformation for septic, traumatic, neoplastic or congenital bone defects. A rat model of the Masquelet technique was developed to further characterize the biological activities of this induced membrane. Our model allows healing of a critical-sized femoral defect (8 mm) by means of this procedure over a period of 18 weeks. Comparison of induced membranes obtained 3, 4, 5 and 6 weeks after PMMA insertion indicated that this tissue changes over time. Several mineralization spots and bone cells were observed in contact with the PMMA, when assessed by Alizarin Red, Von Kossa, Alkaline phosphatase and Tartrate-resistant acid phosphatase staining of the membranes. CTR (calcitonin receptor)- and RANK (Receptor Activator of Nuclear factor Kappa B)- positive mononuclear cells were detected in the induced membrane, confirming the presence of osteoclasts in this tissue. These cells were observed in a thin, highly cellular layer in the induced membrane in contact with the PMMA. Together, these findings suggest that the membrane is able to promote osteointegration of autologous corticocancellous bone grafts during the Masquelet technique by creating local conditions that may be favourable to graft bone remodelling and osteointegration. Copyright © 2014 John Wiley & Sons, Ltd.

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Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane

Cited by 45 publications

References 23 publications

Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia

Debridement Technique and Dead Space Management For Infected Non-Union of the Tibia

Clinical reliability of closed techniques and comparison with open strategies to achieve union at the docking site

Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique

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