In the first operation, radical soft tissue and bone debridement is undertaken. An antibiotic impregnated polymethyl methacrylate (PMMA) cement spacer is implanted at the site of the bone defect which minimizes fibrous tissue invasion into the defect, induces a membrane formation by calling upon the bodys immune system which protects the cancellous graft against resorption (most critical function) and provides some interim stability. Moreover local concentration of an appropriate heat-resistant antibiotic reached is nearly 200 times that what could be reached through a safe systemic intake. Rather than being an inert fibrous structure, the induction membrane is a living tissue that plays an important role in bone healing or union.
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