Masquelet Induced Membrane Technique for The Surgical Treatment of Large Bone Defects: The Reasons for Successes and Failures| Biomed Grid

Segmental bone loss can result from high-energy trauma, infection, tumor resection or revision surgery. For the reconstruction of small defects (<5 cm), autologous bone grafts remain the standard of care [1]. Bone graft harvesting is generally performed in the iliac crest where up to 40 ml of graft material can be collected [2]. Another bone graft source is the reamerirrigator- aspirator (RIA) procedure consisting in a simultaneous reaming of the medullary canal of the long bones and a combined irrigation- aspiration system to collect bone marrow and bony fragments into a closed suction bag (up to 90 ml of graft material) [3]. However, for bone defects more than 5 cm, the application of only autologous bone is suboptimal. Indeed, the grafting material is unable to successfully incorporate into the defect, thus leading to the clearance of the graft [4]. Different surgical strategies have been developed to address this challenge, including the Masquelet induced-membrane technique (IMT). This surgical approach based on the induction of a foreign-body granulation membrane has revolutionized the management of large bone defects. From its introduction in the late eighties to nowadays, still little is known about the mechanism of action of the induced membrane and even more importantly why sometimes IMT fails. At the crossroads of medicine and biology, this review collects information about the reasons for successes and failures of the IMT, thus providing recommendations about this surgical procedure.