F. Gindraux, A. Nallet, B. de Billy, Ch. Meyer, J-Ch. Fricain, L. Nicod, L. Obert
(Besançon, Lyon, Bordeaux)
Background : The induced membrane (IM) is a reconstruction technique for segmental bone loss that requires a two-stage surgery: Firstly: insertion of a cement spacer in the defect allowing foreign body IM formation. Secondly (few months after the first stage): removal of the spacer, and filling the cavity limited by IM with bone autograft. IM avoids bone autograft resorption and promotes consolidation by revascularisation of the bone and secretion of growth factors.
Objective: To reduce this technique to one single surgery, and to avoid waiting for the generation of the IM, we sought a biological membrane which could be inserted in the bone defect at the same time of bone graft filling. We chose the human amniotic membrane (hAM).
Method: We analysed similarities and differences between hAM and IM at tissue & cellular levels by histology and immunocytochemistry.
Result: Thickness: IM = 1.42 mm / hAM = 0.26 mm
Composition: IM = 3 layers / hAM = 5 layers
Main similarities:
- Rich in mesenchymal stem cells able of osteodifferentiation
- Positive expression of type I Collagen, Osteocalcin, Elastin, …
- Similar secretion of: “Inhibitor of fibrosis & scar / Anti-inflammatory & anti-bacterial / Proangiogenic / Osteogenic” molecules
- Time of degradation
Main difference:
- Presence of few vessels in IM.
Conclusion: hAM presents many biological (stem cells, growth factors, components) and matrix similarities with IM. It could be a good candidate as IM substitute to reduce the morbidity of IM technique. In vivo studies, in progress, will be presented.