Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad

Purpose We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. Methods A prospective and observational study was conducted in all patients with a t...

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Veröffentlicht in:	European journal of trauma and emergency surgery (Munich : 2007) Jg. 48; H. 1; S. 593 - 599
Hauptverfasser:	Choufani, Camille, Demoures, Thomas, de l’Escalopier, Nicolas, Chapon, Marie-Pauline, Barbier, Olivier, Mathieu, Laurent
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2022 Springer Nature B.V
Schlagworte:	Adult Arms Bone surgery Bone Transplantation Chad Critical Care Medicine Debridement Deformities Developing countries Emergency medical care Emergency Medicine Fracture Healing Humans Intensive LDCs Legs Medicine Medicine & Public Health Original Article Orthopedics Prospective Studies Reconstructive surgery Retrospective Studies Sports Medicine Surgery Surgical Orthopedics Surgical techniques Tibia Traumatic Surgery Treatment Outcome Chad Chad (country) Bone defect Austere environment Masquelet technique Induced membrane technique Africa
ISSN:	1863-9933, 1863-9941, 1863-9941
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Abstract	Purpose We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. Methods A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application. Results Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia ( n = 8), the femur ( n = 6) or the radius ( n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage. Conclusions This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures.
AbstractList	Purpose We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. Methods A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application. Results Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia ( n = 8), the femur ( n = 6) or the radius ( n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage. Conclusions This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures. We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad. A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application. Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage. This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures. We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad.PURPOSEWe sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad.A prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application.METHODSA prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application.Sixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage.RESULTSSixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage.This series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures.CONCLUSIONSThis series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures. PurposeWe sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of a French forward surgical unit deployed in Chad.MethodsA prospective and observational study was conducted in all patients with a traumatic segmental bone defect in any anatomical location treated by IMT from November 2015 to December 2019. Although IMT was applied by various orthopedic surgeons with variable expertise, all followed the same surgical protocol. Endpoint assessment was performed 12 months after IMT application.ResultsSixteen patients with a mean age of 32.7 years were included in the study. Bone defects were located on the tibia (n = 8), the femur (n = 6) or the radius (n = 2). Thirteen bone defects were infected. After debridement, the mean bone defect length was 4.3 cm. External fixation of the tibia and femur was predominant in both stages. Bone union was achieved in only 8 of the 16 cases at a mean time of 7.6 months. All failures were related to persistent infection or insufficient fixation stability in the second stage.ConclusionsThis series is the first to report IMT use in a forward surgical unit. Despite frequent complications, local patients can benefit from this procedure, which is the only available method for bone reconstruction in areas with limited medical resources. A rigorous technical completion at both stages is crucial to limit septic or mechanical failures.
Author	Demoures, Thomas Chapon, Marie-Pauline Barbier, Olivier Choufani, Camille Mathieu, Laurent de l’Escalopier, Nicolas
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Cites_doi	10.1016/S0020-1383(16)30842-7 10.1007/s00068-019-01217-y 10.4103/0019-5413.181780 10.1136/jramc-2015-000528 10.1097/BOT.0000000000000979 10.1007/s00068-019-01223-0 10.1097/01.bot.0000482081.17682.7d 10.1016/j.injury.2019.12.032 10.1016/j.hansur.2019.01.002 10.1016/j.otsr.2011.11.001 10.1007/s00264-015-2741-7 10.1016/j.ijsu.2017.04.064 10.1016/j.otsr.2014.06.017 10.1097/BOT.0000000000000396 10.1007/s00264-020-04735-2 10.1016/j.otsr.2018.04.013 10.1016/j.otsr.2018.11.012 10.1097/00005373-198408000-00009 10.1016/S0020-1383(16)30840-3
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Keywords	Bone defect Austere environment Masquelet technique Induced membrane technique Africa
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Snippet	Purpose We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource... We sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource setting of... PurposeWe sought to evaluate the results of the Masquelet-induced membrane technique (IMT) for long bone defect reconstruction within the limited-resource...
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SubjectTerms	Adult Arms Bone surgery Bone Transplantation Chad Critical Care Medicine Debridement Deformities Developing countries Emergency medical care Emergency Medicine Fracture Healing Humans Intensive LDCs Legs Medicine Medicine & Public Health Original Article Orthopedics Prospective Studies Reconstructive surgery Retrospective Studies Sports Medicine Surgery Surgical Orthopedics Surgical techniques Tibia Traumatic Surgery Treatment Outcome
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Title	Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad
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