Induced membrane technique for restoration of the first ray following a failed total joint implant: A case study


  • Michael Liette University of Cincinnati Medical Center
  • Allison Hamad University of Cincinnati Medical Center
  • Bryan Hall University of Cincinnati Medical Center
  • Alex Schaeffer University of Cincinnati Medical Center
  • Suhail Masadeh Cincinnati Veterans Affairs Medical Center



lower extremity reconstruction, limb salvage, masquelet technique, osteomyelitis, septic joint, segmental bone defect


The induced membrane technique, also known as the masquelet technique, is a treatment strategy for the management of post traumatic bone defects. Management of segmental bone defects remains a challenging problem for the reconstructive surgeon. Autogenous bone grafting is often utilized for small areas of bone loss. Patients with substantial defects pose a significant reconstructive challenge for limb preservation. The induced membrane technique only requires two procedures and the reported results have been consistently favorable. We present a case of a large first ray segmental bone defect after a failed septic implant treated with the induced membrane technique with successful outcome. At 26 months follow-up, we were able to preserve the length and function of the first ray and the patient was able to return to the previous level of activity.


Pereira R, Perry WC, Crisologo PA, Liette MD, Hall B, Hafez Hassn SG, Masadeh S. Membrane-Induced Technique for the Management of Combined Soft Tissue and Osseous Defects. Clin Podiatr Med Surg. 2021 Jan;38(1):99-110. doi: 10.1016/j.cpm.2020.09.005. Epub 2020 Oct 29. PMID: 33220747.

Alford AI, Nicolaou D, Hake M, McBride-Gagyi S. Masquelet's induced membrane technique: Review of current concepts and future directions. J Orthop Res. 2021 Apr;39(4):707-718. doi: 10.1002/jor.24978. Epub 2021 Jan 13. PMID: 33382115; PMCID: PMC8005442.

Andrzejowski P, Masquelet A, Giannoudis PV. Induced Membrane Technique (Masquelet) for Bone Defects in the Distal Tibia, Foot, and Ankle: Systematic Review, Case Presentations, Tips, and Techniques. Foot Ankle Clin. 2020 Dec;25(4):537-586. doi: 10.1016/j.fcl.2020.08.013. PMID: 33543716.

Rosenbaum D, Timte B, Schmiegel A, Miehlke RK, Hilker A. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int. 2011 Jun;32(6):589-94. doi: 10.3113/FAI.2011.0589. PMID: 21733420.

Aprile I, Galli M, Pitocco D, Di Sipio E, Simbolotti C, Germanotta M, Bordieri C, Padua L, Ferrarin M. Does First Ray Amputation in Diabetic Patients Influence Gait and Quality of Life? J Foot Ankle Surg. 2018 Jan-Feb;57(1):44-51. doi: 10.1053/j.jfas.2017.07.015. PMID: 29268902.

Borkosky SL, Roukis TS. Incidence of re-amputation following partial first ray amputation associated with diabetes mellitus and peripheral sensory neuropathy: a systematic review. Diabet Foot Ankle. 2012;3. doi: 10.3402/dfa.v3i0.12169. Epub 2012 Jan 20. PMID: 22396832; PMCID: PMC3284264.

Borkosky SL, Roukis TS. Incidence of repeat amputation after partial first ray amputation associated with diabetes mellitus and peripheral neuropathy: an 11-year review. J Foot Ankle Surg. 2013 May-Jun;52(3):335-8. doi: 10.1053/j.jfas.2013.02.004. Epub 2013 Mar 26. PMID: 23540756.

Myerson MS, Schon LC, McGuigan FX, Oznur A. Result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length. Foot Ankle Int. 2000 Apr;21(4):297-306. doi: 10.1177/107110070002100405. PMID: 10808969.

Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction des os longs par membrane induite et autogreffe spongieuse [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet. 2000 Jun;45(3):346-53. French. PMID: 10929461.

Masquelet AC. Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction. Langenbecks Arch Surg. 2003 Oct;388(5):344-6. doi: 10.1007/s00423-003-0379-1. Epub 2003 Sep 11. PMID: 13680234.

Kubik J, Aitken S, Buckley R. Induced membrane technique for bone loss in the lower limb - Does the Masquelet technique work as well as its' reputation says it does? Injury. 2022 Feb;53(2):224-226. doi: 10.1016/j.injury.2021.12.036. Epub 2021 Dec 25. PMID: 34980464.

Giannoudis PV, Harwood PJ, Tosounidis T, Kanakaris NK. Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury. 2016 Dec;47 Suppl 6:S53-S61. doi: 10.1016/S0020-1383(16)30840-3. PMID: 28040088.

Niikura T, Jimbo N, Komatsu M, Oe K, Fukui T, Matsumoto T, Hayashi S, Matsushita T, Sakai Y, Itoh T, Kuroda R. Histological analysis of induced membranes in patients whose bone defects were treated with the Masquelet technique to identify factors affecting the vascularity of induced membranes. J Orthop Surg Res. 2021 Apr 13;16(1):248. doi: 10.1186/s13018-021-02404-7. PMID: 33849590; PMCID: PMC8042897.




How to Cite

Liette M, Hamad A, Hall B, Schaeffer A, Masadeh S. Induced membrane technique for restoration of the first ray following a failed total joint implant: A case study. J Int Foot Ankle [Internet]. 2022 Apr. 25 [cited 2022 May 18];1(4). Available from: