Accelerated induced membrane (Masquelet) technique - reaching the goal in one operation less

Fragestellung The induced membrane technique for the treatment of large bone defects has always been a two-step procedure. In the first operation step, a membrane is induced around a spacer, then, in the second step, several weeks later, the removal of the spacer and the filling of the membrane pocket with autologous bone material takes place. The induction process of a biological membrane might be avoided by initially using a biological membrane. In this study, the effect of a human acellular dermis (hADM, Epiflex, DIZG) was evaluated for the treatment of a large (5mm), plate-stabilised femoral bone defect in rats.

Methodik In a critical size defect rat model, hADM was compared to the two-stage induced membrane technique and a bone defect without membrane cover. Syngeneous spongiosa from donor animals was used for defect filling in all groups. The group size in each case was n = 5, the induction time of the membrane was 4 weeks with a healing time after filling of the defect of 8 weeks. Bone healing was assessed biomechanically, radiologically (µCT) and histologically (Movat staining). Degree of vascularization was assessed histologically by means of alpha-SMA staining.

Ergebnisse und Schlussfolgerung In the membrane groups the bones demonstrated similar biomechanical stability and both significant higher values compared to the control group (hADM: 63.2 % ± 29.6 %, p < 0.05 vs. no membrane; induced membrane 52.1 % ± 25.8 %, p < 0.05 vs. no membrane). The defect in both membrane groups was radiologically and histologically almost completely bridged by new bone, furthermore in hADM group significant bone remodeling has frequently occurred while in the control group only callus formation was recorded, and no closed osseous bridging was present. The percentage of a-SMA positive area (vascularization) was lower in the induced membrane and hADM groups compared to the no membrane group (no membrane: 0.96 %, induced membrane: 0.74 %, not significant, hADM: 0.37 %, p < 0.05).

The use of the human acellular dermis leads to equivalent healing results in comparison to the two-stage induced membrane technique. Ongoing bone remodelling and significant decreased blood vessel density suggests that the bone healing was further advanced in the hDAM-group. Assuming that the presented one-stage membrane concept can be transferred into surgical practice, the patient’s suffering is reduced, the treatment time is significantly shortened and the cost of treatment is reduced.

Stichwörter induced membrane technique, Masquelet technique, acellular dermis

Publication History

Article published online:
15 October 2020