• Jan Gessmann, Thomas Rosteius, Hinnerk Baecker, Kavitha Sivalingam, Elvira Peter, Thomas Armin Schildhauer, and Manfred Köller.
• Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
• Eur J Trauma Emerg Surg. 2022 Aug 1; 48 (4): 3051-3061.

PurposeThe induced membrane technique (IMT) is a two-stage surgical procedure for reconstruction of bone defects. Bone grafting (second stage of IMT) is recommend after 4-8 weeks assuming the highest bioactivity of IMs. However, larger studies concerning the biology and maturation of IMs and a potential time dependency of the bioactivity are missing. Therefore, aim of this study was the time-dependent structural and cellular characterization of cement spacer IMs concomitantly to an analysis of membrane bioactivity.MethodsIMs from 60 patients (35-82 years) were obtained at different maturation stages (1-16 weeks). IMs were studied by histology and co-culture with mesenchymal stem cells (MSC). IM lysates were analyzed by ELISA and protein microarray.ResultsIncreasing vascularization and fibrosis were found in membranes older than 4 and 7 weeks, respectively. MSC grew out from all membranes and all membranes enhanced proliferation of cultured MSC. Osteocalcin and osteopontin (in membrane lysates or induced in MSC by membrane tissue) were found over all time points without significant differences. In contrast to alkaline phosphatase activity, increasing levels of osteoprotegerin were found in membranes.ConclusionThe histological structure of IMs changes during growth and maturation, however, biologically active MSC and factors related to osteogenesis are found over all time points with minor changes. Thus, membranes older than 8 weeks exert regenerative capacities comparable to the younger ones. The postulated narrow time frame of 4-8 weeks until bone grafting can be questioned and surgeons may choose timing for the second operation more independently and based on other clinical factors.© 2021. The Author(s).

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