SLR - June 2023 - Isaac Kline, DPM
Title: The Free Tissue Transfer–Masquelet–Reamer-Irrigator-Aspirator Bone Graft Orthoplastic Approach for Lower Extremity ReconstructionReference: Maruccia M, Vicenti G, Carrozzo M, Caizzi G, Di Summa PG, Moretti B, Giudice G, Elia R. The Free Tissue Transfer-Masquelet-Reamer-Irrigator-Aspirator Bone Graft Orthoplastic Approach for Lower Extremity Reconstruction. Plast Reconstr Surg. 2022 Jun 1
Level of Evidence: IV
Reviewed by: Isaac Kline, DPM
Residency Program: West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
Podiatric Relevance: Podiatrists may encounter patients with complex lower extremity defects secondary to trauma or chronic osteomyelitis that require bone grafting and soft tissue reconstruction. In such cases, the use of free tissue transfer combined with the Masquelet technique and Reamer Irrigator Aspirator (RIA) bone graft may offer a reconstructive option that can provide reliable bone union and satisfactory soft tissue coverage. This approach may be a valuable alternative to traditional bone grafting methods, which may not be feasible or effective in such cases. The aim of this article is to present a current orthoplastic approach for the management of composite extended (more than 6 cm) osteocutaneous defects of the lower extremity.
Methods: The authors retrospectively reviewed the medical records of 11 patients with an average bone gap length of 87.3mm who underwent lower extremity reconstruction with the free tissue transfer-Masquelet-RIA bone graft approach between January 2017 and December 2020. The indications for surgery were adult patients (>18 years of age) with segmental bone loss of the lower extremity caused by acute trauma (Gustilo type IIIB fracture) or nonunion (septic/aseptic). The technique consists of combining the Masquelet technique with a free tissue flap which helps revascularize the spacer as the first stage. The second stage consists of using the RIA technique to obtain autograft from the iliac crest in order to fill the periosteal cavity formed in stage one.
Results: All 11 patients achieved successful bone union at an average 20.4 (+/- 3.3) weeks postoperatively with the duration of the first stage of induced membrane technique being an average of 52 days. The average AOFAS score was 83.3 (4.9). Complications included venous insufficiency, soft-tissue infection and hematoma.
Conclusions: The free tissue transfer-Masquelet-RIA bone graft approach appears to be a viable option for lower extremity reconstruction in cases of bone defect, chronic osteomyelitis, or tumor resection. The authors suggest that this technique may be especially useful in cases where traditional bone grafting methods have failed or are not feasible. This technique offers foot and ankle surgeons an option for limb salvage in patients with segmental critical-sized bone defects and large soft-tissue deficits.