The Concept of Induced Membrane for Reconstruction of Long Bone Defects
Section snippets
Principles of technique
The reconstruction needs to have two different operative stages (Fig. 1). The first stage is comprised of a radical debridement, a soft-tissue repair by flaps when needed, and the insertion of a polymethyl methacrylate (PMMA) cement spacer into the bone defect. The second stage is performed 6 to 8 weeks later, when the definitive healing of soft tissue is acquired. The spacer is removed, but the membrane that is induced by the cement is left in place Fig. 1A. The cavity is filled up by
Retrospective clinical experience
Between 1986 and 1999,4 the authors did a series of 35 reconstructions of long bone segmental defects ranging from 5 to 24 cm after debridement. Lower limb was involved in 29 cases and the majority of cases were posttraumatic septic nonunions of the leg (23 cases) (Figs. 2 and 3). Upper limb was concerned in six cases (Fig. 4). Soft-tissue repair by flaps was needed in 28 cases (14 free flaps and 14 pedicled flaps). Immediate complications concerned the failure of the free flaps in three
Prospective clinical study
At the beginning of 2000, the authors thought that it could be interesting to associate local injection of recombinant human BMP-7 (Osigraft, Strycker, Biotech) with the bone autograft to enhance a quick formation of cortical bone.
From 2000 to 2004, 11 subjects had the two stages procedure for reconstruction of a wide diaphyseal defect. At the second stage, the morcellized cancellous bone autograft was mixed with a dose of 3.5 mg of eptotermin alpha and the preparation was left to the
The Use of Additional Growth Factors
Recombinant human BMP-7 and recombinant human BMP-2 have been proved efficacious in improving accelerating bone healing in orthotopic animal models.12 The BMP target is the perivascular connective tissue cells in the host bone bed. Clinical studies have also shown the possibility to repair segmental defects of the tibia by cancellous bone graft augmented with human morphogenetic protein13 and to augment new-bone development.14, 15, 16
BMP-7 has been shown equivalent to autogenous iliac crest
Summary
The authors think that the concept of membrane is well established as a bone reconstruction promotion by preventing the bone-graft resorption and by playing an important role in revascularization and consolidation. However, many problems remain to be solved relative to the stabilization, the type of material for reconstruction, the use of recombinant human growth factors, and the addition of stem cells.
Finally, this concept of membrane as a biological chamber could probably be extended to other
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