title: Preliminary Results of the Induced Membrane Technique for the Reconstruction of Large Bone Defects.
abstract: BACKGROUND
  During past decades, gradual bone transplant using external fixators and vascularized fibular or rib transplants widely contributed to solve difficult problems related to the reconstruction of large bone defects in children. However, these surgeries are time consuming and require specialized surgical skills, not always available in a general hospital setting, mainly in rural areas.
  
  
  OBJECTIVE
  To report the preliminary results of the more recently described induced membrane technique in a consecutive series of 8 children and to identify some factors related to the procedure's success.
  
  
  METHODS
  Nine consecutive children with bone defects ranging from 5 to 14 cm were included in the study. The age at surgery ranged from 3 to 16 years. There were 3 congenital pseudarthrosis (CP) of the fibula, 1 CP of the tibia, 1 Ewing sarcoma of the tibia, 1 Ewing sarcoma of the ulna, 1 tibial osteosarcoma, 1 fibular osteosarcoma, and 1 chronic diffuse tibial osteomyelitis. The procedure was performed according to the original Masquelet's description in 2 stages. Follow-up ranged from 1 to 7 years.
  
  
  RESULTS
  The child with tibial osteosarcoma died 3 months after the surgery from complications related to chemotherapy. Among the 8 remaining children, 6 healed uneventfully, and 2 required revision with additional grafting and/or better internal fixation, one with Ewing sarcoma of the tibia and a 13-cm bone defect and the second with CP of the fibula. Both of them had suboptimal internal stabilization.
  
  
  CONCLUSIONS
  The induced membrane technique is a useful, efficient, and simple alternative to highly specialized surgical procedures used for the reconstruction of large bone defects in children. Risk factors for failure include chemotherapy, suboptimal bone fixation, and persistent axial malalignment.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopedic Surgery, Hotel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
authors.forename: Toni M
authors.initials: TM
authors.lastname: Mansour
authors.forename: Ismat B
authors.initials: IB
authors.lastname: Ghanem
mesh_terms: D000293:Adolescent; D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000601:surgery*; D012516:Osteosarcoma / Q000601:surgery*; D011542:Pseudarthrosis / Q000151:congenital* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery
chemical_list: D001843:Bone Cements