scholarly journals The deleterious relationship of Pseudomonas aeruginosa and Induced Membranes in infected non-union treatment

2021 ◽  
Vol 12 (1) ◽  
pp. 388-391
Author(s):  
Thiyagarajan U ◽  
Senthil Loganathan ◽  
Raghavendar ◽  
Pradeep P
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bone Graft ◽  
Bone Defect ◽  
Bone Defects ◽  
Reconstructive Procedures ◽  
Induced Membrane ◽  
Non Union ◽  
Masquelet Technique ◽  
Slime Layer ◽  
Pseudomonas Infection

The Masquelet technique was originally described for the treatment of an infected non-union with an extensive bone defect where a staged protocol was needed to first eliminate an infection then secondarily bone graft a defect. Though this is a versatile technique, certain limitations/ complications must be recognized. The study was done between 2012 to 2019 at SRIHER university. 19 patients in whom the Masquelet technique has failed is taken into study. 17 male and two females, with a mean age of 31 years (range of 13 yrs. – 51 yrs.) with a mean follow up of 12 months. The 19 patients who presented with Pseudomonas aeruginosa infected non-union of the tibia and femur with bone defects underwent the Masquelet technique. All patients failed to form adequate induced membrane at the non-union site. Infected non-union with a bone defect is difficult to treat. Bone defects of 2cms can be treated by cancellous bone grafting. Defects more than 4-5cms will require specialized reconstructive procedures to prevent amputation. The two common techniques used are Ilizarov technique with bone transport and bone graft into an induced membrane as described by Masquelet. This study shows a high failure rate of the Masquelet technique with Pseudomonas infection. The most difficult issue faced by the surgeon in treating P. aeruginosa is its ability to develop resistance to multiple classes of antibiotics during the course of treating the patient. Masquelet technique is used extensively for the treatment of infective non-union. Pseudomonas secretes a slime layer that may lead to a weak or deficient formation of the induced membrane. And the elution of antibiotics may not be adequate for intramedullary osteomyelitis with pseudomonas growth. This limits the Masquelet technique in the management of infected non-union with pseudomonas infection.

scholarly journals Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hichem Issaoui ◽  
Mohammed Reda Fekhaoui ◽  
Moheddin Jamous ◽  
Alain-Charles Masquelet
Keyword(s):  
Bone Graft ◽  
Bone Defect ◽  
Bony Union ◽  
Induced Membrane ◽  
Masquelet Technique ◽  
Membrane Technique ◽  
Defect Area ◽  
Induced Membrane Technique ◽  
Large Bone

The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations.

Reconstruction of Large Bone Defects and Complex Non-Unions Using a Free Fibular Bone Graft and a Supplementary Allograft

2020 ◽  
Author(s):  
Selina Gaida ◽  
Uwe Schweigkofler ◽  
Wibke Moll ◽  
Michael Sauerbier ◽  
Reinhard Hoffmann
Keyword(s):  
Bone Graft ◽  
Case Series ◽  
Bone Defects ◽  
Bone Transplantation ◽  
Patient Comfort ◽  
Masquelet Technique ◽  
Specialized Center ◽  
Free Fibula ◽  
Large Bone ◽  
Large Bone Defects

AbstractLarge bone defects or complex pseudarthrosis represent an interdisciplinary challenge. Established surgical procedures include autogenous cancellous bone graft, the Masquelet technique or bone transfer via segment transport as well as free microvascular bone transplantation. However, the successful use of all these techniques requires a specialized center with great interdisciplinary expertise. In the following case series we describe the technique of free fibula transplantation and additional allograft. In both cases a good functional result with full mechanical strength of the affected extremity and satisfactory patient comfort has been achieved. In the second case, implant failure with the necessity of revision endoprosthetics occurred during the procedure.

scholarly journals Combined use of the Ilizarov non-free bone plasty and Masquelet technique in patients with acquired bone defects and pseudarthrosis

2020 ◽  
Vol 26 (4) ◽  
pp. 532-538
Author(s):  
D.Yu. Borzunov ◽  
◽  
D.S. Mokhovikov ◽  
S.N. Kolchin ◽  
E.N. Gorbach ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Soft Tissues ◽  
Bone Defects ◽  
Bone Transport ◽  
Long Bone ◽  
Cement Spacer ◽  
Technical Problems ◽  
Induced Membrane ◽  
Masquelet Technique ◽  
Membrane Technique

Introduction The Masquelet induced membrane technique is effective in the management of acquired heterogeneous long bone defects and pseudarthrosis. The combination of the Masquelet technology and Ilizarov non-free bone grafting seems promising and reduces the risks of recurrence at long-term in patients with congenital pseudarthrosis. Purpose Presentation of new technological solutions that allow combining the advantages of the Ilizarov bone transport and Masquelet bone grafting in patients with acquired bone defects. Materials and methods Retrospective assessment of the results of bone reconstruction in 10 patients who were treated by a combination of Ilizarov and Masquelet bone grafting technologies to repair long bone defects after failures of previous treatment. Fragments of the biomembrane formed around the cement spacer temporarily replacing the tibial gap after resection bone defect or pseudarthrosis were examined in all patients. The studies were carried out using a Reichard sledge microtome, an AxioScope stereomicroscope and an AxioCam ICc 5 digital camera, a JSM- 840 scanning electron microscope and an INCA-200 Energy X-ray electron probe microanalyzer. Results and discussion The combined Masquelet technique and Ilizarov non-free bone plasty provide the conditions that are favorable for reparative processes of the transported fragments. After removal of the spacer, there is a tunnel formed in the interfragmental gap, the walls of which are made of the induced membrane. Bone transport is carried out without technical problems through the compromised tissues which are debrided at the time of distraction initiation, outside the scars. At the same time, there are low risks of inflammation around the transosseous elements; there is no danger of cutting and perforation of soft tissues by transported fragments. Conclusions Complete organotypic rearrangement of the distraction regenerate with the use of Ilizarov non-free bone plasty and the Masquelet technique excludes the possibility of deformities or fractures at the level of newly formed bone areas. Active distraction histogenesis ensures the closure of soft tissue defects without additional reconstructive plastic interventions. The revealed dependence of the induced membrane blood supply on the method of treatment previously used might be a criterion for predicting the treatment outcome in patients with acquired bone defects and pseudarthrosis.

scholarly journals In VivoOsteogenesis of Vancomycin Loaded Nanohydroxyapatite/Collagen/Calcium Sulfate Composite for Treating Infectious Bone Defect Induced by Chronic Osteomyelitis

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Xiaojie Lian ◽  
Kezheng Mao ◽  
Xi Liu ◽  
Xiumei Wang ◽  
Fuzhai Cui
Keyword(s):  
Bone Graft ◽  
Bone Defect ◽  
Calcium Sulfate ◽  
Chronic Osteomyelitis ◽  
Rabbit Model ◽  
Calcium Sulphate ◽  
Bone Defects ◽  
Bone Graft Substitute ◽  
Calcium Sulphate Hemihydrate

A novel antibacterial bone graft substitute was developed to repair bone defects and to inhibit related infections simultaneously. This bone composite was prepared by introducing vancomycin (VCM) to nanohydroxyapatite/collagen/calcium sulphate hemihydrate (nHAC/CSH). XRD, SEM, and CCK-8 tests were used to characterize the structure and morphology and to investigate the adhesion and proliferation of murine osteoblastic MC3T3-E1 cell on VCM/nHAC/CSH composite. The effectiveness in restoring infectious bone defects was evaluatedin vivousing a rabbit model of chronic osteomyelitis. Ourin vivoresults implied that the VCM/nHAC/CSH composite performed well both in antibacterial ability and in bone regeneration. This novel bone graft substitute should be very promising for the treatment of bone defect-related infection in orthopedic surgeries.

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