This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
Takahiro Niikura
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0951-5812
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Rich vascularity of the induced membrane (IM) is important for Masquelet reconstruction surgery. The factors affecting IM vascularity are not completely understood. This study aimed to investigate these factors using histological samples of human IMs.
Methods
We retrospectively evaluated 36 patients whose bone defects were treated using the Masquelet technique. Two clinical pathologists analyzed histological sections of IM pieces (1-cm2). The number of blood vessels per 1 mm2 was counted and compared among men and women, femur or tibia, with and without free flap surgery, antibiotic impregnation to the cement, osteogenesis inside the membrane, smoking, and diabetes mellitus. The number of blood vessels within the same patient was compared among different time points. Correlation analysis was performed among blood vessel numbers and patient age, duration of cement spacer placement, and histological grading scales (inflammation, foreign body reaction, and fibrosis).
Results
IM formation with rich vascularity and some inflammation, foreign body reaction, and fibrosis was histologically confirmed in all patients. We found 37.4 ± 19.1 blood vessels per 1 mm2. Blood vessel numbers were significantly lower in patients with than in those without free flap surgery. Blood vessel numbers were higher in patients with osteogenesis inside the IM. No significant correlations were found in any of the analyses.
Conclusion
Sex, patient age, smoking, diabetes mellitus, femur or tibia, duration of cement spacer placement, and antibiotic impregnation to the cement did not affect IM vascularization. IM vascularization was reduced in patients with than in those without free flap surgery.
Keywords
Masquelet technique, induced membrane, bone defect, vascularity, histology
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CURRENT STATUS: Under Review
Version 1
Posted 10 Mar, 2021
No community comments so far
Editorial decision: Minor revision
On 20 Mar, 2021
Review #1 received
Received 19 Mar, 2021
Reviewer #2 agreed
On 15 Mar, 2021
Review #2 received
Received 15 Mar, 2021
Review #? received
Received 05 Mar, 2021
Reviewer #1 agreed
On 05 Mar, 2021
Reviewers invited
Invitations sent on 01 Mar, 2021
Editor assigned
On 28 Feb, 2021
Submission checks complete
On 28 Feb, 2021
Editor invited
On 28 Feb, 2021
First submitted
On 26 Feb, 2021
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Subject Areas
Orthopedic Surgery
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This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Takahiro Niikura
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0951-5812
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 10 Mar, 2021
No community comments so far
Editorial decision: Minor revision
On 20 Mar, 2021
Review #1 received
Received 19 Mar, 2021
Reviewer #2 agreed
On 15 Mar, 2021
Review #2 received
Received 15 Mar, 2021
Review #? received
Received 05 Mar, 2021
Reviewer #1 agreed
On 05 Mar, 2021
Reviewers invited
Invitations sent on 01 Mar, 2021
Editor assigned
On 28 Feb, 2021
Submission checks complete
On 28 Feb, 2021
Editor invited
On 28 Feb, 2021
First submitted
On 26 Feb, 2021
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Rich vascularity of the induced membrane (IM) is important for Masquelet reconstruction surgery. The factors affecting IM vascularity are not completely understood. This study aimed to investigate these factors using histological samples of human IMs.
Methods
We retrospectively evaluated 36 patients whose bone defects were treated using the Masquelet technique. Two clinical pathologists analyzed histological sections of IM pieces (1-cm2). The number of blood vessels per 1 mm2 was counted and compared among men and women, femur or tibia, with and without free flap surgery, antibiotic impregnation to the cement, osteogenesis inside the membrane, smoking, and diabetes mellitus. The number of blood vessels within the same patient was compared among different time points. Correlation analysis was performed among blood vessel numbers and patient age, duration of cement spacer placement, and histological grading scales (inflammation, foreign body reaction, and fibrosis).
Results
IM formation with rich vascularity and some inflammation, foreign body reaction, and fibrosis was histologically confirmed in all patients. We found 37.4 ± 19.1 blood vessels per 1 mm2. Blood vessel numbers were significantly lower in patients with than in those without free flap surgery. Blood vessel numbers were higher in patients with osteogenesis inside the IM. No significant correlations were found in any of the analyses.
Conclusion
Sex, patient age, smoking, diabetes mellitus, femur or tibia, duration of cement spacer placement, and antibiotic impregnation to the cement did not affect IM vascularization. IM vascularization was reduced in patients with than in those without free flap surgery.
Figure 1
Figure 2
Figure 3
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