2025, Vol. 29 ›› Issue (28): 6083-6093

Application of induced membrane technique for repairing critical-sized bone defects: advantages and future development

Li Shuyuan1, Yang Dawen1, Zeng Zhanpeng1, Cai Qunbin1, Zhang Jingtao2, Zhou Qishi1   

Abstract: BACKGROUND: The induced membrane technique (Masquelet technique) is a novel two-stage surgical approach for the reconstruction of large bone defects, gaining increasing popularity in clinical applications. However, the precise mechanism underlying its bone defect repair is still not fully understood.
OBJECTIVE: To review the background, repair mechanism and advantages of the induced membrane technique, the characteristics of the induced membrane, membrane-bone graft communication, selection of animal models, types and morphology of bone cement, the effects of loaded antibiotics on the induced membrane, choice of fixation methods, and bone tissue engineering materials to provide new insights for the future treatment of critical-sized bone defects and the improvement of the induced membrane technique.
METHODS: A literature search was conducted in PubMed, Web of Science, and CNKI databases, covering publications from 1986 to 2024. A total of 890 references were retrieved. Manual screening and analysis were performed based on inclusion criteria related to the fundamental research of induced membrane technique, excluding those with poor relevance to the topic and duplicates. The included literature comprised original experimental studies, reviews, meta-analyses and other relevant publications. Finally, 72 articles were included for summary and analysis.
RESULTS AND CONCLUSION: (1) The mechanism underlying the bone defect repair using this technique remains unclear, but both the membrane and bone grafting are indispensable. (2) The induced membrane is a distinctively layered tissue rich in various bone-forming related cells, growth factors, and blood vessels, with its vascularization and secretion of growth factors dynamically changing over time. (3) In terms of animal model selection, sheep are more similar to humans in anatomical structure, weight-bearing patterns, and bone remodeling. However, rats are more suitable considering their lower feeding costs, easier handling, and shorter modeling period. (4) Polymethyl methacrylate is not the only material that can be used to induce a biomembrane, and there may be more suitable materials capable of inducing higher-quality biomembranes. The recommended dose of antibiotics (primarily vancomycin) is 1-4 g per 40 g polymethyl methacrylate. (5) For animal fixation, especially in rats, the use of steel plates is more widespread, providing a more reliable and reproducible fixation method. (6) In the future, there is potential for new materials to replace autogenous bone and enhance the bone repair capabilities of the Masquelet technique.

Key words: induced membrane technique, bone defect, animal model, bone cement, bone tissue engineering, engineered bone