Induced membrane technique for reconstruction after bone tumor resection in children: A preliminary study - 05/04/12

Doi : 10.1016/j.otsr.2011.11.008

F. Chotel ^a,^⁎ , L. Nguiabanda ^a, P. Braillon ^b, R. Kohler ^a, J. Bérard ^a, K. Abelin-Genevois ^a
^a Department of Pediatric Orthopaedic Surgery, Lyon Mother and Child Teaching Hospital Center, Civilian Hospital Group of Lyon, Lyon 1 Claude-Bernard University, 59, boulevard Pinel, 69677 Bron, France
^b Children Department of Medical Imagery Service, Lyon Mother and Child Teaching Hospital Center, 69677 Lyon, France

Corresponding author. Tel.: +33 4 27 86 92 07; fax: +33 4 27 85 54 53.

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Summary

Aim

Segmental long-bone defect due to tumor resection remains a challenge to treat. The induced membrane technique is a new alternative for biological reconstruction. During the first stage, a cement spacer is inserted after bone resection and stabilisation. The cement spacer is removed during a second stage procedure performed after chemotherapy, and cortico-cancellous bone autograft was placed in the biological induced chamber. The aim of this study was to assess preliminary results in eight children.

Patients and methods

This prospective study included six girls and two boys, with a mean age of 12.1years (range 9.5 to 18) and treated for a mean 15cm defect (range 10 to 22cms) due to resection of osteosarcoma (n=4), Ewing sarcoma (n=3) and low grade sarcoma. All patients except one, were given pre- and postoperative chemotherapy. Surgery was performed for three patients with a distal femur tumor, two patients with a proximal tibial tumor and three patients who had proximal humerus, shaft of humerus and fibular tumors. Fixation was mainly performed with locking compression plate (n=4) and locked nail (n=2). The mean operating times for first and second step procedures were 4.8 and 4h respectively. The healing process was radiologically assessed.

Results

After a mean follow-up of 21.6months (15 to 30), all patients were free of disease and seven had bony union. For the lower limb reconstructions, full weight bearing was possible after a mean of 116days (range90 to 150) following the second stage. Mean time to bone union was 4.8months (1.5 to 10). The early Musculoskeletal Tumor Society (MSTS) score was 25.2/30 (range 20–30). Complications were: non-union (n=1), paradoxical graft resorption (n=1) requiring graft revision.

Conclusion

This two stage procedure reduces the operating time during the first stage and it also reduces early complications. Rapid bone union is objectively obtained despite major bone resection and the patients receiving chemotherapy.

Significance

The induced membrane technique could be an excellent alternative for biological reconstruction after tumor resection in children.

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Keywords : Bone reconstruction, Bone graft, Bone tumor, Children, Induced membrane, Bone defect, Cancellous bone graft, Growth factors, Tumor resection