Masquelet technique for reconstruction of osseous defects in a gunshot fracture of the proximal thigh--a case study.

Treatment of osseous defects of the extremities is a constantly recurring challenge in modern reconstructive surgery. This applies, in particular, to military surgery, especially to the sequelae of gunshot and blast injuries. Severe soft-tissue damage and inevitable contamination lead to an increased rate of infection. Repetitive surgical debridement involving the bone must be performed at regular intervals. Frequent outcomes are osseous defects that call for a consistent therapeutic concept adapted to the individual patient. The Masquelet technique is an additional bone reconstruction method with which to sufficiently treat initially infected long bone defects in multiple operations. Following radical debridement, the resulting bone defect is completely filled with a bone cement spacer loaded with antibiotics. At the boundary layer between the spacer and soft tissue, a membrane expressing growth factors will develop over several weeks. This has a favorable effect on the successful transplantation and ossification of autologous cancellous graft following spacer removal. This technique will be illustrated by a case study. Since this technique has already proved successful in reconstructing defects of up to 25 cm, it is an alternative to various callus distraction methods as well as vascularized bone transfer.