Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed
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ORIGINAL ARTICLE
Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad Camille Choufani1 · Thomas Demoures1 · Nicolas de l’Escalopier2 · Marie‑Pauline Chapon1 · Olivier Barbier1,3 · Laurent Mathieu2,3 Received: 14 April 2020 / Accepted: 21 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. Methods A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application. Results Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage. Conclusions This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures. Keywords Africa · Austere environment · Induced membrane technique · Masquelet technique · Bone defect
Introduction The Masquelet-induced membrane technique (IMT) is a two-stage procedure for reconstruction of long bone defects related to trauma, infection debridement or tumor excision. Because of its simplicity, replicability, and reliability, IMT has spread all over the world in the last decade [1, 2]. It is an alternative to complex methods such as bone transportation * Camille Choufani [email protected] 1
Clinic of Orthopedics and Traumatology, Begin Military Hospital, 69 Avenue de Paris, 94160 Saint‑Mandé, France
2
Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
3
French Military Health Service Academy, Ecole du Val‑de‑Grâce, 1 Place Alphonse Laveran, 75005 Paris, France
and vascularized bone transfer that require high-level expertise in reconstructive surgery and sophisticated equipment. In addition, the unique biological and structural properties of the induced membrane allow bone healing almost independent of the extent of the bone defect [
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