TY - JOUR
T1 - Resorbable polylactide membrane for the treatment of segmental bone defects
AU - Nahm, Nickolas J.
AU - Conway, Janet D.
N1 - Funding Information:
JDC is a consultant for Bonesupport, Orthofix, Smith+Nephew, and Zimmer Biomet, receives fellowship support from Biocomposites, is on the MicroGenDX Advisory Board, and her spouse receives royalties from the University of Florida. The following organizations supported the institution of JDC: Biocomposites, DePuy Synthes Companies, MHE Coalition, Orthofix, OrthoPediatrics, Pega Medical, Smith+Nephew, Stryker, and Zimmer Biomet. NJN has no conflicts to report.
Funding Information:
No funding was received to conduct this study. The authors thank Alvien Lee and Robert P. Farley, BS, for their invaluable assistance with the manuscript.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2022/2
Y1 - 2022/2
N2 - Introduction: Segmental bone defects are a challenging clinical problem. In animal studies and craniomaxillofacial surgery, resorbable polylactide membrane (OrthoMesh; DePuy Synthes, West Chester, PA) shows promise for treatment of bone defects. This study presents the results of the treatment of segmental bone defects with resorbable polylactide membrane, bone morphogenic protein-2 (BMP-2), and autograft. Methods: This study was approved by the institutional review board. All patients with a segmental bone defect treated with a resorbable polylactide membrane by a single surgeon from 2010 to 2019 were retrospectively reviewed. Data related to demographic variables, surgical details, and union were collected. Results: Eleven patients with median age of 37 years (range 22–62 years) were included in the study with segmental bone defects in the tibia (n = 3), femur (n = 4), or forearm (n = 4). Median bone defect size was 6 cm (range 3–12 cm). Etiology of bone defects included osteomyelitis (n = 7), oncologic resection (n = 3), and post-traumatic aseptic nonunion (n = 1). Flap coverage was performed in two patients. Median radiographic follow-up was 24 months (range 5–75 months). Ten patients (10/11) achieved union at a median of 17 months (range 5–46 months). Seven patients required reoperation for any reason with six patients requiring repeat grafting. Conclusions: To our knowledge, this study is the largest series of patients with segmental bone defects treated with resorbable polylactide membrane. Resorbable polylactide membrane in combination with BMP-2 and autograft represents a safe and effective method of bone graft containment in segmental bone defects measuring up to 12 cm in this series. Ten of 11 patients achieved union at a median time of 16 months with 6 patients requiring repeat grafting. These results compare favorably with the induced membrane technique. This study is limited by its retrospective design, absence of control and comparison groups, and low patient numbers. Future prospective randomized study of the induced membrane technique and resorbable polylactide membrane should be undertaken to determine preferred approaches for treatment of segmental bone defects.
AB - Introduction: Segmental bone defects are a challenging clinical problem. In animal studies and craniomaxillofacial surgery, resorbable polylactide membrane (OrthoMesh; DePuy Synthes, West Chester, PA) shows promise for treatment of bone defects. This study presents the results of the treatment of segmental bone defects with resorbable polylactide membrane, bone morphogenic protein-2 (BMP-2), and autograft. Methods: This study was approved by the institutional review board. All patients with a segmental bone defect treated with a resorbable polylactide membrane by a single surgeon from 2010 to 2019 were retrospectively reviewed. Data related to demographic variables, surgical details, and union were collected. Results: Eleven patients with median age of 37 years (range 22–62 years) were included in the study with segmental bone defects in the tibia (n = 3), femur (n = 4), or forearm (n = 4). Median bone defect size was 6 cm (range 3–12 cm). Etiology of bone defects included osteomyelitis (n = 7), oncologic resection (n = 3), and post-traumatic aseptic nonunion (n = 1). Flap coverage was performed in two patients. Median radiographic follow-up was 24 months (range 5–75 months). Ten patients (10/11) achieved union at a median of 17 months (range 5–46 months). Seven patients required reoperation for any reason with six patients requiring repeat grafting. Conclusions: To our knowledge, this study is the largest series of patients with segmental bone defects treated with resorbable polylactide membrane. Resorbable polylactide membrane in combination with BMP-2 and autograft represents a safe and effective method of bone graft containment in segmental bone defects measuring up to 12 cm in this series. Ten of 11 patients achieved union at a median time of 16 months with 6 patients requiring repeat grafting. These results compare favorably with the induced membrane technique. This study is limited by its retrospective design, absence of control and comparison groups, and low patient numbers. Future prospective randomized study of the induced membrane technique and resorbable polylactide membrane should be undertaken to determine preferred approaches for treatment of segmental bone defects.
KW - Limb reconstruction
KW - Osteomyelitis
KW - Polylactide membrane
KW - Segmental bone defect
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U2 - 10.1016/j.injury.2021.11.024
DO - 10.1016/j.injury.2021.11.024
M3 - Article
C2 - 34852920
AN - SCOPUS:85120349630
SN - 0020-1383
VL - 53
SP - 376
EP - 380
JO - Injury
JF - Injury
IS - 2
ER -