Clinical efficacy of Masquelet technique combined with artificial dermis in the treatment of Gustilo type IIIB injuries with large-area bone exposure: A retrospective study

To compare the clinical efficacy of Masquelet technique combined with artificial dermis versus conventional vacuum sealing drainage (VSD) technique in the treatment of Gustilo type IIIB injuries with large-area bone exposure. Clinical data of 63 patients with Gustilo type IIIB injuries and large-area bone exposure admitted from January 2023 to February 2025 were retrospectively analyzed. Based on the actual treatment received, patients were retrospectively divided into the observation group (Masquelet technique combined with artificial dermis, n=32) and the control group (conventional VSD technique, n=31). This was a non-randomized retrospective study. To reduce selection bias, propensity score matching (PSM) was used to balance baseline characteristics between the two groups. Bone union rate, bone healing time, pain scores, range of motion (ROM) recovery rate, limb function scores, quality of life scores, and complication rates were compared between the two groups. After PSM, 32 patients in the observation group and 31 in the control group were included in the final analysis, with no statistically significant differences in baseline characteristics between groups (P>0.05). For bone healing indicators, the complete union rate in the observation group was 87.5% (28/32), significantly higher than 64.5% (20/31) in the control group (χ²=4.513, P=0.034, RR=1.36, 95%CI: 1.03-1.79). Bone healing time in the observation group was (14.2±3.6) weeks, significantly shorter than (18.7±4.8) weeks in the control group (t=4.068, P<0.001, MD=-4.5 weeks, 95%CI: -6.7 to -2.3 weeks). There were no statistically significant differences in partial union rate (9.4% vs 22.6%, P=0.131) or nonunion rate (3.1% vs 12.9%, P=0.182) between groups. For functional recovery indicators, after Bonferroni correction (significance level P<0.025), at 12 months postoperatively, the observation group had significantly lower resting pain scores than the control group (median 1.0 vs 2.0, Z=-3.220, corrected P=0.002), significantly lower activity pain scores (2.1±1.2 vs 3.0±1.4, MD=-0.9, 95%CI: -1.6 to -0.2, corrected P=0.018), and significantly higher ROM recovery rate (91.5±7.8% vs 84.2±10.3%, MD=7.3%, 95%CI: 2.6%-12.0%, corrected P=0.006); differences at 6 months postoperatively did not reach the corrected significance level. Limb function scores (DASH, Lysholm, AOFAS) did not reach statistical significance at either time point after correction. SF-36 assessment showed that at 12 months postoperatively, the observation group had significantly higher role-physical scores (68.4±13.2 vs 58.9±15.6, MD=9.5, 95%CI: 2.2-16.8, corrected P=0.024), bodily pain scores (73.8±9.6 vs 65.2±12.1, MD=8.6, 95%CI: 3.1-14.1, corrected P=0.006), and physical component summary scores (72.8±9.2 vs 65.0±11.6, MD=7.8, 95%CI: 2.5-13.1, corrected P=0.010). The total complication rate in the observation group was 15.6% (5/32), significantly lower than 45.2% (14/31) in the control group (χ²=6.482, P=0.011, RR=0.35, 95%CI: 0.15-0.81). The results of this retrospective cohort study suggest that Masquelet technique combined with artificial dermis for treating Gustilo type IIIB injuries with large-area bone exposure may be associated with higher complete bone union rate, shorter bone healing time, better functional recovery, and lower complication rate. However, given the retrospective non-randomized design of this study, causal relationships cannot be established. These findings should be considered preliminary evidence requiring verification through prospective randomized controlled trials.