Masquelet technique combined with flap transplantation for infectious bone and soft tissue defects of lower leg_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MENG Congpeng , YE Shuming ,  JING Juehua

Department of Orthopedics, the Second Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P.R.China;

Corresponding?author：

JING Juehua, Email: jhjpaper@sina.com

Keywords：

Masquelet technique; bone defect; soft tissue defect; wound repair; infection; lower leg

DOI：

10.7507/1002-1892.201911025

Video：

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Objective To investigate the effectiveness of Masquelet technique combined with flap transplantation in treatment of infectious bone and soft tissue defects of the lower leg.Methods Between January 2013 and January 2017, 35 cases of infectious bone and soft tissue defects of lower leg were treated with Masquelet technique combined with flap transplantation. There were 21 males and 14 females, with an average of 31.5 years (mean, 25-55 years). All patients were tibial fractures caused by trauma and the infections occurred after debridement or internal fixation. The time from injury to admission was 1 to 6 months, with an average of 3.2 months. Defect located at the proximal leg in 11 cases, the middle leg in 11 cases, and the distal leg in 13 cases. The length of tibia defect after debridement ranged from 5.6 to 11.2 cm, with an average of 7.1 cm. The size of soft tissue defect ranged from 14.2 cm×6.9 cm to 17.3 cm×8.7 cm. Bacterial culture of purulent secretion of wound was positive in 18 cases. After debridement, the bone cement was used to fill the bone defect and the flap transplantation was used to repair the wound. The bone cement was taken out at 8 to 12 weeks after the one-stage operation, and the bone defect was repaired with autogenous iliac bone or combined with artificial bone.Results Three cases had necrosis at the distal edge of the flap after one-stage operation, and survived after dressing change. The other flaps survived successfully, and the wounds healed by first intention. All incisions healed by first intention after two-stage operation. All patients were followed up 24-32 months, with an average of 27 months. The color of the flap was similar to that of the surrounding normal tissue, and its texture was good. X-ray reexamination showed that all bone defects healed after 6-8 months, with an average of 6.7 months. At 9 months after two-stage operation, according to the revised Edwards tibial fracture evaluation standard, 19 cases were excellent, 14 cases were good, and 2 cases were poor, the excellent and good rate was 94.3%. The American Orthopedic Ankle Association (AOFAS) score was 60-98, with an average of 81.3. And 21 cases were excellent, 11 were good, and 3 were fair, with an excellent and good rate of 91.4%.Conclusion Masquelet technique combined with flap transplantation is an effective treatment for infectious bone and soft tissue defects of lower leg.

Citation： MENG Congpeng, YE Shuming, JING Juehua. Masquelet technique combined with flap transplantation for infectious bone and soft tissue defects of lower leg. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 756-760. doi: 10.7507/1002-1892.201911025 Copy

1.	Moralle MR, Stekas ND, Reilly MC, et al. Salvage of a below knee amputation utilizing rotationplasty principles in a patient with chronic tibial osteomyelitis. J Orthop Case Rep, 2016, 6(2): 57-62.
2.	van Niekerk AH, Birkholtz FF, de Lange P, et al. Circular external fixation and cemented PMMA spacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017716242.
3.	謝肇. 四肢長骨創傷后骨髓炎診斷與治療的難點及挑戰. 中華創傷雜志, 2015, 31(4): 289-293.
4.	Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res, 1990, (250): 81-104.
5.	Ikuta Y. Vascularized bone graft. Nihon Seikeigeka Gakkai Zasshi, 1991, 65(11): 1143-1151.
6.	Watson JT. Nonunion with extensive bone loss: reconstruction with Ilizarov techniques and orthobiologics. Operative Techniques in Orthopaedics, 2008, 18(2): 95-107.
7.	Mauffrey C, Hake ME, Chadayammuri V, et al. Reconstruction of long bone infections using the induced membrane technique. J Orthop Trauma, 2015, 30(6): e188-e193.
8.	Masquelet AC. Induced membrane technique: pearls and pitfalls. J Orthop Trauma, 2017, 31(Suppl 5): S36-S38.
9.	Metsemakers WJ, Morgenstern M, McNally MA, 等. 骨折相關性感染定義的共識. 中華骨科雜志, 2018, 38(9): 513-518.
10.	Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician, 2001, 63(12): 2413-2420.
11.	Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg, 2009, 23(2): 80-89.
12.	蔡崧, 崔興宇, 王國祥, 等. 不典型慢性骨髓炎的 MRI 表現. 影像診斷與介入放射學, 2013, 22(6): 471-474.
13.	鄒林, 蔡錦方, 劉立峰, 等. 小腿外側腓骨皮瓣交腿修復合并血管損傷的大段脛骨骨感染及缺損. 中華骨科雜志, 2012, 32(7): 675-680.
14.	Kakwani R, Siddique M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 2014, 15(7): 349-353.
15.	Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
16.	Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am, 2010, 41(1): 27-37.
17.	Zwetyenga N, Catros S, Emparanza A, et al. Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-betaTCP: animal model study and preliminary results in patients. Int J Oral Maxillofac Surg, 2009, 38(12): 1289-1297.
18.	Viateau V, Bensidhoum M, Guillemin G, et al. Use of the induced membrane technique for bone tissue engineering purposes: animal studies. Orthop Clin North Am, 2010, 41(1): 49-56.
19.	Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res, 2004, 22(1): 73-79.
20.	Ren L, Kang Y, Browne C, et al. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone, 2014, 64: 173-182.
21.	謝肇, 喻勝鵬. 膜誘導技術治療感染性骨不連、骨缺損. 中華骨科雜志, 2018, 38(9): 570-576.
22.	熊洪濤, 莊永青, 方錫池, 等. 脛后動脈皮支逆行交腿皮瓣與外固定器聯合應用修復32例小腿難治性創面. 中華顯微外科雜志, 2017, 40(2): 172-173.
23.	張輝, 殷渠東, 顧三軍, 等. 空心多孔抗生素骨水泥體外成形、體內灌洗的誘導膜技術治療骨髓炎. 中國修復重建外科雜志, 2015, 29(11): 1397-1400.
24.	Mouzopoulos G, Kanakaris NK, Kontakis G, et al. Management of bone infections in adults: the surgeon’s and microbiologist’s perspectives. Injury, 2011, 42(Suppl 5): S18-S23.
25.	Pinder R, Barlow G. Osteomyelitis of the hand. J Hand Surg (Eur Vol), 2016, 41(4): 431-440.
26.	邱旭升, 陳一心, 戚曉陽, 等. 誘導膜技術治療感染性骨缺損的療效分析. 中國修復重建外科雜志, 2017, 31(9): 1064-1068.
27.	楊佐明, 戴士峰, 劉昆鵬, 等. 保留內固定物治療四肢骨折術后早期感染15例. 中華創傷雜志, 2013, 29(1): 62-64.
28.	Mok JM, Guillaume TJ, Talu U, et al. Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine (Phila Pa 1976), 2009, 34(6): 578-583.

1. Moralle MR, Stekas ND, Reilly MC, et al. Salvage of a below knee amputation utilizing rotationplasty principles in a patient with chronic tibial osteomyelitis. J Orthop Case Rep, 2016, 6(2): 57-62.
2. van Niekerk AH, Birkholtz FF, de Lange P, et al. Circular external fixation and cemented PMMA spacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017716242.
3. 謝肇. 四肢長骨創傷后骨髓炎診斷與治療的難點及挑戰. 中華創傷雜志, 2015, 31(4): 289-293.
4. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res, 1990, (250): 81-104.
5. Ikuta Y. Vascularized bone graft. Nihon Seikeigeka Gakkai Zasshi, 1991, 65(11): 1143-1151.
6. Watson JT. Nonunion with extensive bone loss: reconstruction with Ilizarov techniques and orthobiologics. Operative Techniques in Orthopaedics, 2008, 18(2): 95-107.
7. Mauffrey C, Hake ME, Chadayammuri V, et al. Reconstruction of long bone infections using the induced membrane technique. J Orthop Trauma, 2015, 30(6): e188-e193.
8. Masquelet AC. Induced membrane technique: pearls and pitfalls. J Orthop Trauma, 2017, 31(Suppl 5): S36-S38.
9. Metsemakers WJ, Morgenstern M, McNally MA, 等. 骨折相關性感染定義的共識. 中華骨科雜志, 2018, 38(9): 513-518.
10. Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician, 2001, 63(12): 2413-2420.
11. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg, 2009, 23(2): 80-89.
12. 蔡崧, 崔興宇, 王國祥, 等. 不典型慢性骨髓炎的 MRI 表現. 影像診斷與介入放射學, 2013, 22(6): 471-474.
13. 鄒林, 蔡錦方, 劉立峰, 等. 小腿外側腓骨皮瓣交腿修復合并血管損傷的大段脛骨骨感染及缺損. 中華骨科雜志, 2012, 32(7): 675-680.
14. Kakwani R, Siddique M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 2014, 15(7): 349-353.
15. Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
16. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am, 2010, 41(1): 27-37.
17. Zwetyenga N, Catros S, Emparanza A, et al. Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-betaTCP: animal model study and preliminary results in patients. Int J Oral Maxillofac Surg, 2009, 38(12): 1289-1297.
18. Viateau V, Bensidhoum M, Guillemin G, et al. Use of the induced membrane technique for bone tissue engineering purposes: animal studies. Orthop Clin North Am, 2010, 41(1): 49-56.
19. Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res, 2004, 22(1): 73-79.
20. Ren L, Kang Y, Browne C, et al. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone, 2014, 64: 173-182.
21. 謝肇, 喻勝鵬. 膜誘導技術治療感染性骨不連、骨缺損. 中華骨科雜志, 2018, 38(9): 570-576.
22. 熊洪濤, 莊永青, 方錫池, 等. 脛后動脈皮支逆行交腿皮瓣與外固定器聯合應用修復32例小腿難治性創面. 中華顯微外科雜志, 2017, 40(2): 172-173.
23. 張輝, 殷渠東, 顧三軍, 等. 空心多孔抗生素骨水泥體外成形、體內灌洗的誘導膜技術治療骨髓炎. 中國修復重建外科雜志, 2015, 29(11): 1397-1400.
24. Mouzopoulos G, Kanakaris NK, Kontakis G, et al. Management of bone infections in adults: the surgeon’s and microbiologist’s perspectives. Injury, 2011, 42(Suppl 5): S18-S23.
25. Pinder R, Barlow G. Osteomyelitis of the hand. J Hand Surg (Eur Vol), 2016, 41(4): 431-440.
26. 邱旭升, 陳一心, 戚曉陽, 等. 誘導膜技術治療感染性骨缺損的療效分析. 中國修復重建外科雜志, 2017, 31(9): 1064-1068.
27. 楊佐明, 戴士峰, 劉昆鵬, 等. 保留內固定物治療四肢骨折術后早期感染15例. 中華創傷雜志, 2013, 29(1): 62-64.
28. Mok JM, Guillaume TJ, Talu U, et al. Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine (Phila Pa 1976), 2009, 34(6): 578-583.

Chinese Journal of Reparative and Reconstructive Surgery

Masquelet technique combined with flap transplantation for infectious bone and soft tissue defects of lower leg

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