Thumb salvage after infected toe-to-hand vascularised transfer with induced membrane technique

The induced membrane technique of bone reconstruction described by A.C. Masquelet is a well-known and efficient procedure for the lower limbs but is rarely used in the hand. After debridement, the technique consists first in inducing a foreign body membrane by the implantation of a cement methyl methacrylate polymer spacer and then filling the defect by cancellous bone. We report a case of induced membrane to save an infected vascularized custom made toe-to-hand transfer. The second stage was done 3 months after the first. Bone healing was obtained 4 months later. No specific complication was observed. Induced membrane technique seems to be another possibility for bony defects of the hand besides vascularised or non-vascularised grafts. It is essential to apply the principles of the two stages of the procedure, first respecting the foreign body membrane and second stable fixation of the graft. In sepsis, this allows a second surgical debridement without compromising the graft. Masquelet technique, simple and reproducible, seems an effective salvage procedure for bone defects of the thumb. (C) 2011 Elsevier Masson SAS. All rights reserved.