Masquelet TECHNIQUE COMBINED WITH TISSUE FLAP GRAFTING FOR TREATMENT OF BONE DEFECT AND SOFT TISSUE DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIZongyuan ,  TANGShitian , WANGJun , ZHANGDingwei , SHIBo , WANGTao

Department of Orthopaedics, Mianyang Central Hospital, Mianyang Sichuan, 621000, P. R. China;

Corresponding author：

TANGShitian, Email: kylwkt@163.com

Keywords：

Masquelet technique; Composite defects; Bone defect; Soft tissue defect; Tissue flap

DOI：

10.7507/1002-1892.20160196

Video：

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Objective To explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect. Methods Between August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years (mean, 37.1 years). The time between injury and treatment was 15 days to 39 months (mean, 0.9 months). Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was (5.7±1.8) cm in length, and the soft tissue defect was 5 cm×4 cm to 13 cm×11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation. Results Eighteen patients followed up 10-38 months (mean, 24.3 months). After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15-57 weeks (mean, 25.3 weeks) after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89.7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case. Conclusion The Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.

Citation： LIZongyuan, TANGShitian, WANGJun, ZHANGDingwei, SHIBo, WANGTao. Masquelet TECHNIQUE COMBINED WITH TISSUE FLAP GRAFTING FOR TREATMENT OF BONE DEFECT AND SOFT TISSUE DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(8): 966-970. doi: 10.7507/1002-1892.20160196 Copy

1.	黄金亮, 唐辉, 徐永清.骨髓炎流行病学.国际骨科学杂志, 2011, 32(2):94-95.
2.	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.
3.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
4.	曹发奇, 刘国辉, 杨述华, 等.封闭负压引流术结合外科手术治疗创伤后慢性骨髓炎.临床骨科杂志, 2010, 13(5):489-491.
5.	张朝, 杨增华, 陈瑞, 等.庆大霉素珠链治疗慢性骨髓炎疗效分析.四川医学, 2000, 21(3):232.
6.	Cypher TJ, Grossiman JP. Biological principles of bone graft healing. J Foot Ankle Surg, 1996, 35(5):413-417.
7.	Biau DJ, Pannier S, Masquelet AC, et al. Case report:reconstruction of a 16-cm diaphyseal defect after Ewing's resection in a child. Clin Orthop Relat Res, 2009, 467(2):572-577.
8.	El-Alfy BS, Ali AM. Management of segmental skeletal defects by the induced membrane technique. Indian J Orthop, 2015, 49(6):643-648.
9.	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.
10.	Aho OM, Lehenkari P, Ristiniemi J, et al. The Mechanism of action of induced membranes in bone repair. J Bone Joint Surg (Am), 2013, 95(7):597-604.
11.	Klaue K, Knothe U, Anton C, et al. Bone regeneration in long-bone defects:tissue compartmentalisation? In vivo study on bone defects in sheep. Injury, 2009, 40(Suppl 4):S95-S102.
12.	Azi ML, Teixeira A, Cotias RB, et al. Membrane induced osteogenesis in the management of post-traumatic bone defects. J Orthop Trauma, 2016.[Epub ahead of print].
13.	曾炳芳, 喻鑫罡.肢体复合组织缺损修复的进展.中华创伤骨科杂志, 2004, 6(1):16-18.
14.	Zeltzer AA, Van Landuyt K. Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap. J Plast Reconstr Aesthet Surg, 2012, 65(2):42-45.
15.	Moucharafieh R, Wehbe J, Maalouf G, et al. Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction. Foot Ankle Surg, 2008, 14(2):82-88.
16.	殷渠东, 孙振中, 顾三军.应用Masquelet技术修复骨缺损的研究进展.中国修复重建外科杂志, 2013, 27(10):1273-1276.
17.	丛海波, 隋海明, 王晨霖, 等.骨搬运治疗四肢大段骨缺损的临床研究.中华骨科杂志, 2008, 28(7):567-570.
18.	吴仕斌, 喻爱喜, 邓凯, 等.开放性骨折骨缺损治疗的临床研究.武汉大学学报(医学版), 2009, 30(2):236-237.
19.	Ilizarov GA, Ledyaev VI. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969. Clin Orthop Relat Res, 1992, (280):7-10.
20.	De la Parra-Márquez M, Zorola-Tellez O, Cárdenas-Rodríguez S, et al. Versatility of the microvascular fibular flap in limb reconstruction. Cir Cir, 2016, 84(3):213-219.

1. 黄金亮, 唐辉, 徐永清.骨髓炎流行病学.国际骨科学杂志, 2011, 32(2):94-95.
2. 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.
3. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
4. 曹发奇, 刘国辉, 杨述华, 等.封闭负压引流术结合外科手术治疗创伤后慢性骨髓炎.临床骨科杂志, 2010, 13(5):489-491.
5. 张朝, 杨增华, 陈瑞, 等.庆大霉素珠链治疗慢性骨髓炎疗效分析.四川医学, 2000, 21(3):232.
6. Cypher TJ, Grossiman JP. Biological principles of bone graft healing. J Foot Ankle Surg, 1996, 35(5):413-417.
7. Biau DJ, Pannier S, Masquelet AC, et al. Case report:reconstruction of a 16-cm diaphyseal defect after Ewing's resection in a child. Clin Orthop Relat Res, 2009, 467(2):572-577.
8. El-Alfy BS, Ali AM. Management of segmental skeletal defects by the induced membrane technique. Indian J Orthop, 2015, 49(6):643-648.
9. 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.
10. Aho OM, Lehenkari P, Ristiniemi J, et al. The Mechanism of action of induced membranes in bone repair. J Bone Joint Surg (Am), 2013, 95(7):597-604.
11. Klaue K, Knothe U, Anton C, et al. Bone regeneration in long-bone defects:tissue compartmentalisation? In vivo study on bone defects in sheep. Injury, 2009, 40(Suppl 4):S95-S102.
12. Azi ML, Teixeira A, Cotias RB, et al. Membrane induced osteogenesis in the management of post-traumatic bone defects. J Orthop Trauma, 2016.[Epub ahead of print].
13. 曾炳芳, 喻鑫罡.肢体复合组织缺损修复的进展.中华创伤骨科杂志, 2004, 6(1):16-18.
14. Zeltzer AA, Van Landuyt K. Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap. J Plast Reconstr Aesthet Surg, 2012, 65(2):42-45.
15. Moucharafieh R, Wehbe J, Maalouf G, et al. Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction. Foot Ankle Surg, 2008, 14(2):82-88.
16. 殷渠东, 孙振中, 顾三军.应用Masquelet技术修复骨缺损的研究进展.中国修复重建外科杂志, 2013, 27(10):1273-1276.
17. 丛海波, 隋海明, 王晨霖, 等.骨搬运治疗四肢大段骨缺损的临床研究.中华骨科杂志, 2008, 28(7):567-570.
18. 吴仕斌, 喻爱喜, 邓凯, 等.开放性骨折骨缺损治疗的临床研究.武汉大学学报(医学版), 2009, 30(2):236-237.
19. Ilizarov GA, Ledyaev VI. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments. 1969. Clin Orthop Relat Res, 1992, (280):7-10.
20. De la Parra-Márquez M, Zorola-Tellez O, Cárdenas-Rodríguez S, et al. Versatility of the microvascular fibular flap in limb reconstruction. Cir Cir, 2016, 84(3):213-219.

Chinese Journal of Reparative and Reconstructive Surgery

Masquelet TECHNIQUE COMBINED WITH TISSUE FLAP GRAFTING FOR TREATMENT OF BONE DEFECT AND SOFT TISSUE DEFECT

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