[Reconstruction of the long bones by the induced membrane and spongy autograft].
ABSTRACT In the reported series of 35 cases bone reconstruction of large diaphyseal defects was performed in two stages. The first stage was the insertion into the defect of a cement spacer which was responsible for the formation of a pseudosynovial membrane. The second stage was the reconstruction of the defect by a huge fresh autologous cancellous bone graft. The membrane induced by the spacer prevents the resorption of the graft and favors its vascularity and its corticalisation. In weight bearing diaphyseal segments the normal walking was possible at 8.5 months on average. The length of the reconstructed defects was 4 to 25 cm.
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ABSTRACT: Wide resection of infected bone improves the odds of achieving remission of infection in patients with chronic osteomyelitis. Aggressive debridement is followed by the creation of large bone defects. The use of antibiotic-impregnated PMMA spacers, as a customized dead space management tool, has grown in popularity. In addition to certain biological advantages, the spacer offers a therapeutic benefit by serving as a vehicle for delivery of local adjuvant antibiotics. In this study, we investigate the efficacy of physician-directed antibiotic-impregnated PMMA spacers in achieving remission of chronic tibial osteomyelitis. This retrospective case series involves eight patients with chronic osteomyelitis of the tibial diaphysis managed with bone transport through an induced membrane using circular external fixation. All patients were treated according to a standardized treatment protocol. A review of the anatomical nature of the disease, the physiological status of the host and the outcome of treatment in terms of remission of infection, time to union and the complications that occurred was carried out. Seven patients, with a mean bone defect of 7 cm (range 5-8 cm), were included in the study. At a mean follow-up of 28 months (range 18-45 months), clinical eradication of osteomyelitis was achieved in all patients without the need for further reoperation. The mean total external fixation time was 77 weeks (range 52-104 weeks), which equated to a mean external fixation index of 81 days/cm (range 45-107). Failure of the skeletal reconstruction occurred in one patient who was not prepared to continue with further reconstructive surgery and requested amputation. Four major and four minor complications occurred. The temporary insertion of antibiotic-impregnated PMMA appears to be a useful dead space management technique in the treatment of post-infective tibial bone defects. Although the technique does not appear to offer an advantage in terms of the external fixation index, it may serve as a useful adjunct in order to achieve resolution of infection.Strategies in Trauma and Limb Reconstruction 04/2015; DOI:10.1007/s11751-015-0221-7
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ABSTRACT: Cases of limb salvage following skeletal trauma involving significant bone loss pose a particular challenge to the reconstructive surgeon. Certain techniques for addressing this complex issue have been advanced in recent years and have met with considerable success. The Masquelet technique involves a staged procedure in which a temporary skeletal stabilization is paired with implantation of an antibiotic spacer and left in place for 6–8 weeks, during which time a " pseudomembrane " forms around the cement spacer. During the second stage of the procedure, the pseudomembrane is incised, the antibiotic spacer removed, and bone graft is placed. We present a case of significant segmental femur loss in a 19-year-old male opting for limb salvage in which a 17-centimeter segmental loss of bone was essentially regrown using a combination of the Masquelet technique with supplemental endosteal fixation.11/2014; 2015. DOI:10.1155/2015/369469
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ABSTRACT: A relatively simple technique to address large segmental bone defects in the upper extremity is described, along with a case example. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.The Journal Of Hand Surgery 01/2015; 40(3). DOI:10.1016/j.jhsa.2014.12.007 · 1.66 Impact Factor