[Use of the induced membrane technique for the treatment of bone defects in the hand or wrist, in emergency]. / Pertes de substance osseuse à la main et au poignet traitées en urgence par technique de la membrane induite (technique de Masquelet).

A prospective study is reported concerning 11 cases of bone defect of the hand and wrist treated by the induced membrane technique. Ten men and one woman with an average age of 49 yrs (17-72) sustained a high-energy trauma with severe mutilation of digit and hand but with intact pulp. Eight cases of open finger fractures with composite loss of substance and three cases of bone and joint infection (thumb, wrist, fifth finger) were included. All cases were treated by the induced membrane technique which consists in stable fixation, flap if necessary, and in filling the bone defect by a cement methyl methacrylate polymere (PMMA) spacer. A secondary procedure at two months is needed where the cement is removed and the void is filled by cancellous bone. The key point of this induced membrane technique is to respect the foreign body membrane which formed around the cement spacer creating a biologic chamber. Bone union was evaluated prospectively by X-ray and CT scan by a surgeon not involved in the treatment. Failure was defined as non-union at one year, or uncontrolled sepsis at one month. Two cases failed to achieve bone union. No septic complications occurred and all septic cases were controlled. In nine cases, bone union was achieved within four months (three to 12). Evidence of osteoid formation was determined by a bone biopsy in one case. Masquelet first reported 35 cases of large tibial non-union defects treated by the induced membrane technique. The cement spacer promotes foreign body membrane induction constituting a biological chamber. Works on animal models reported by Pellissier and Viateau demonstrated membrane properties: secretion of growths factors (VEGF, TGF beta1, BMP2) and osteoinductive cellular activity. The induced membrane seems to mimic a neoperiosteum. This technique is useful in emergency or septic conditions where bone defects cannot be treated by shortening. It avoids microsurgery and is limited by availability of cancellous bone.

[Posterior interosseous free flap because of absence of posterior interossous pedicle. A report of an individualised salvage procedure and of an exceptional anatomical variation. Review of the literature]. / Lambeau interosseux postérieur libre pour absence d'artère interosseuse postérieure. Une adaptation technique a une variation anatomique rare. Cas clinique et revue de la littérature.

The posterior interosseous flap on the posterolateral aspect of the forearm is appreciated for its thinness and the length of its vascular pedicle. Arterial supply to the flap comes from the posterior interosseous artery, which gives off several cutaneous branches. This flap is most often used with its distal pedicle as its artery presents anastomoses with the anterior interosseous artery and the dorsal arterial carpal network. However, its dissection is often difficult because of anatomical variants and is not reliable in case of traumatic history at the distal forearm. A case is reported where no posterior interosseous pedicle was found and the flap was subsequently transferred as a free flap supplied by a perforating branch arising from the anterior interosseous artery.