Is Masquelet Technique A Successful Viable Treatment In Reconstructing Large Tumor Bone Gaps in Adolescent and Adult?

Objectives: The reconstruction of large bony defect caused by tumor resection can be managed by different technique like bone graft, Masquelet technique, mega-prosthesis etc. Literature lacks studies discussing Masquelet technique in tumor cases especially pertaining to infected tumor in adults. We aimed to determine ۱) How often and how fast is the bone healing achieved after resection greater than ۱۰ cm bone in tumour patient’s using Masquelet technique?, ۲) Whether Masquelet technique can achieve optimum outcomes in adult infected cases too?Methods: We reviewed ۱۵۴ patients of benign & malignant tumour managed by us between ۲۰۱۳ and ۲۰۱۹. Patients belonging to all the age group with infected tumor/diaphysial tumor/periarticular tumor, where single stage surgery or mega-prosthesis is not a viable option and were treated with Masquelet technique for reconstructing a bone defect of at least ۱۰ cm were included in our study. We evaluated outcomes of eight patients for four parameters i.e. bony union, healing index, number of re-do surgeries required and limb length discrepancy.Results: Mean age of our study group was ۲۰.۲۵ years and patients followed for mean duration of ۳.۳۶ years. Mean bone loss after tumor resection was ۱۳.۱ cm (range = ۱۱.۵ cm to ۱۵ cm). There was no sign of recurrence of tumor in any patient at the time of last follow up. Average time required to achieve bony union was ۲۳.۲۵ months (mean healing index of ۱.۶۷ months/cm). All but one patient achieved bony union. Mean limb length discrepancy seen was ۱.۴۴cm. Infected cases showed low healing index with higher percentage of re-do surgeries.Conclusion: Induced membrane technique is quick, safe and reliable alternative method of reconstruction to megaprosthesis in cases with all age group where risk of failure of mega-prosthesis is high, either due to infection or shorter expected lifespan of prosthesis. However, obtaining union can be a difficult preposition in infected tumor cases and multiple surgeries may be required to get the desired result even after two stages. However, a comparative study with large sample size is required to further validate our results. Level of evidence: IV

Keywords:

Adult age , chemotherapy , Diaphysial tumour , Induced membrane technique , Infected tumor , Masquelet technique , Mega-prosthesis