Induced membrane technique: a critical literature analysis and proposal for a failure classification scheme
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REVIEW ARTICLE
Induced membrane technique: a critical literature analysis and proposal for a failure classification scheme Laurent Mathieu1,2 · Marjorie Durand3 · Jean‑Marc Collombet3 · Arnaud de Rousiers1 · Nicolas de l’Escalopier1 · Alain‑Charles Masquelet4 Received: 6 September 2020 / Accepted: 31 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The reconstruction of long-bone segmental defects remains challenging, with the three common methods of treatment being bone transport, vascularized bone transfer, and the induced membrane technique (IMT). Because of its simplicity, replicability, and reliability, usage of IMT has spread all over the world in the last decade, with more than 300 papers published in the PubMed literature database on this subject so far. Most of the clinical studies have reported high rates of bone union, yet some also include more controversial results with frequent complications and revision surgeries. At the same time, various experimental research efforts have been designed to understand and improve the biological properties of the induced membrane. This literature review aims to provide an overview of IMT clinical results in terms of bone union and complications and to compare them with those of other reconstructive procedures. In light of our findings, we then propose an original classification scheme of IMT failures distinguishing between preventable and nonpreventable failures. Keywords Bone defect · Bone repair · Induced membrane technique · Failure · Masquelet technique
Introduction The reconstruction of segmental bone defects remains a challenge for orthopedic and trauma surgeons, especially in cases with infection. Treatment modalities include techniques such as cortico-cancellous autograft, bone transport (BT), vascularized bone transfer, and the two-stage Masquelet induced membrane (IM) technique (IMT) [1]. Because of its simplicity, reliability, and efficiency, even for large defects, the latter has spread all over the world in the last * Laurent Mathieu [email protected] 1
Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
2
French Military Health Service Academy, Ecole du Val‑de‑Grâce, 1 place Alphonse Laveran, 75005 Paris, France
3
Military Biomedical Research Institute (IRBA), 1 place Général Valérie André, 91220 Brétigny‑sur‑Orge, France
4
Department of Orthopedic, Trauma and Hand Surgery, Saint-Antoine Hospital, 184 rue du Faubourg Saint‑Antoine, 75012 Paris, France
decade [2, 3]. The IMT presents strong advantages as it does not require any sophisticated equipment or microsurgical skills to perform and has a healing time almost independent of the defect length [3]. Nowadays, more than 300 articles dealing with IMT are listed in the PubMed database. Numerous authors have published retrospective or prospective series of variable sample sizes and degrees of homogeneity. Most of these clinical studies have reported high bone union
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