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Has the Induced Membrane Technique Revolutionalized the Treatment of Bone Defects?

Giannoudis, Peter V. MD, FACS, FRCS

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Techniques in Orthopaedics: March 2016 - Volume 31 - Issue 1 - p 2
doi: 10.1097/BTO.0000000000000169
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The management of postfracture fixation complications, such as infection, nonunion, and critical size bone defects remains a hot topic of debate within the world of reconstructive surgery. Despite the advances made in microsurgical techniques, free tissue transfer, implant design, molecular medicine, antibiotics and tissue engineering approaches, limb salvage not infrequently fails, leading to amputation of the affected extremity.

The introduction by Ilizarov of the concept of distraction osteogenesis and bone transport for bone regeneration has given another dimension in the management of these complex cases presenting with severe soft-tissue and bone loss. However, the course of treatment is lengthy, complicated with setbacks and not all patients can withstand physically and mentally this method of reconstruction.1 Ongoing painful stimuli, reoperations, pin site infections, social implications of keeping the frame for several months if not years, failure of bone consolidation, nonunion of the docking site, and loss of alignment are some of the currently encountered problems with the use of frames.

In the mid 1990s, the publication by Masquelet of an alternative option to manage extensive soft-tissue and bone loss with the induced membrane technique opened a new era in the management of bone defects.2 This technique consists of 2 stages. Firstly, soft-tissue reconstruction and implantation of a cement spacer (PMMA) at the site of the bone defect. The local foreign body reaction induces a pseudoperiosteum (membrane) tissue layer within a period of 4 to 6weeks, which is highly angiogenic, possessing inductive properties, and having a very high cellular content.

The second stage involves the removal of the cement spacer and implantation of autologous or allogeneic bone graft in the site of the defect which is well contained by the induced membrane layer. The induced membrane because of its properties facilitates vascularization of the graft, host acceptance, and integration and restoration of bone continuity and function.

Since the original publication of this technique, its application has expanded worldwide. More and more knowledge is becoming available to the scientific community by the work and collaboration of researchers and clinicians. A number of manuscripts have been published reporting on the effectiveness, successes, and failures of this unique approach to achieve bone repair.3–8

In this issue, a number of articles have been put together to allow clinicians to become more familiar with the technique to apply it successfully in their units. It is clear that this technique can be further evolved using tissue engineering approaches and eventually become a dominating strategy for bone reconstruction.

I would like to express the appreciation of all the editorial board members of the journal to all the authors for their contributions to throw more light into this fascinating concept of bone regeneration.


1. Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J. 2013;95-B:1673–1680.
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;45:346–353.
3. Scholz AO, Gehrmann S, Glombitza M, et al.. Reconstruction of septic diaphyseal bone defects with the induced membrane technique. Injury. 2015;46(suppl 4):S121–S124.
4. Chadayammuri V, Hake M, Mauffrey C. Innovative strategies for the management of long bone infection: a review of the Masquelet technique. Patient Saf Surg. 2015;9:32.
5. Bosemark P, Perdikouri C, Pelkonen M, et al.. The Masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect. J Orthop Res. 2015;33:488–495.
6. Christou C, Oliver RA, Yu Y, et al.. The Masquelet technique for membrane induction and the healing of ovine critical sized segmental defects. PLoS One. 2014;9:e114122.
7. Ronga M, Ferraro S, Fagetti A, et al.. Masquelet technique for the treatment of a severe acute tibial bone loss. Injury. 2014;45(suppl 6):S111–S115.
8. Bieler D, Franke A, Willms A, et al.. Masquelet technique for reconstruction of osseous defects in a gunshot fracture of the proximal thigh--a case study. Mil Med. 2014;179:e1053–e1058.
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