Bibliometric and Knowledge-Mapping Analysis of Induced Membrane (Masquelet) Technique in Bone Infection

Summary

This study conducted a comprehensive bibliometric and knowledge-mapping analysis of research on the induced membrane (Masquelet) technique in bone infection, revealing its global development trends and thematic evolution.

Abstract

The study aims to delineate the evolutionary trajectory, global collaborative networks, intellectual structure, and shifting clinical frontiers of the induced membrane technique (IMT, Masquelet) for managing osteomyelitis and severe infected bone defects. Publications from 2001 to 2026 were retrieved from the Web of Science Core Collection database. Bibliometric and visualization analyses were conducted using R Bibliometrix. A carefully curated dataset of 307 foundational original articles from 40 countries was included. The logistic growth model (R²=0.827) indicates the field is transitioning from a period of novel expansion into clinical maturation. Geographically, France pioneered the foundational high-impact literature, whereas China has recently experienced an exponential surge in publication volume, albeit operating largely within domestic research silos with limited international crosstalk. Author co-citation algorithms unmasked three distinct theoretical pillars driving the field: the foundational anatomical and physiological conceptualization of the induced membrane, the ongoing clinical dialectic against distraction osteogenesis (the Ilizarov bone transport paradigm), and the rigorous integration of classical Cierny-Mader osteomyelitis principles. Crucially, thematic mapping and Sankey evolution revealed a profound clinical paradigm shift. Early historical enthusiasm for biological modifiers has been aggressively replaced by contemporary pragmatic limb salvage strategies (2022–2026), heavily characterized by burst keywords such as flap and amputation. Bibliometric analysis reveals that IMT research has evolved from early technique validation into a core strategy for complex multidisciplinary extremity salvage. Current frontiers emphasize aggressive infection eradication and massive composite defect management. Future advancements necessitate transnational multicenter trials to establish standardized clinical protocols.

Introduction

Bone infection, spanning osteomyelitis, infected nonunion, and segmental bone loss, remains a recalcitrant challenge driven by biofilm persistence, compromised vascularity, and soft-tissue damage, with prolonged disability and high reoperation risk underscoring the need for strategies that pair reliable infection control with robust regeneration^1,2,3. The Masquelet (induced membrane) technique (IMT) has gained prominence as a two-stage solution that unites radical debridement and dead-space management with a biologically active chamber for delayed grafting^4<....

Protocol

Data collection
To accurately capture the bibliometric landscape of the induced membrane technique (IMT) in bone infection, a comprehensive literature search was conducted in the Web of Science Core Collection (WoSCC) on March 14, 2026. The topic query was: TS = (induced membrane) OR (induced membrane technique) OR (masquelet technique)) AND TS = (bone infection). Records were limited to original research articles (document type: Article) published in English, with no temporal restriction (database inception to the search date). To ensure literature exhaustiveness and avoid missing key landmark studies, a backward citation tracking (snowballing)....

Results

Evolution of academic interest in IMT for bone infection
Following rigorous screening, the bibliometric trajectory of the 307 final included articles strictly begins at the year 2000, aligning perfectly with the historical milestone when Alain Masquelet formally introduced the IMT. As shown in the annual scientific production curve (Figure 2A), the evolution of academic interest in applying IMT for bone infection can be divided into distinct phases. During the initial in.......

Discussion

The management of massive infectious bone defects has historically been one of the most formidable challenges in orthopedic traumatology^18,19. Since its initial conceptualization, the IMT has fundamentally transformed reconstructive limb salvage strategies^19,20. Over the past two decades, what began as a novel surgical trick has matured into a mainstream clinical paradigm²⁰. This b.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Adobe Illustrator	Adobe Inc.	Version 2023	Used for preparing and refining figures for publication, including charts and graphs.
Antibiotic-loaded PMMA spacers	Smith & Nephew	Catalog # 67890	Used for infection control in Masquelet technique.
Bibliometrix (R package)	R Project / Aria & Cuccurullo	Version 4.1	Used for bibliometric analysis, data cleaning, and thematic evolution of research trends.
Cell Culture Media	Gibco	Catalog # 12345	Used for culturing primary cells for regenerative medicine studies.
CiteSpace	Chaomei Chen, Drexel University	Version 5.7.R5	Used for co-citation analysis, burst detection, and reference trends.
Data Source: Bibliographic Records (Plain Text & BibTeX formats)	Exported from WOSCC	Retrieved on 1st October 2025	Contains bibliographic data from 946 English-language original articles related to IMT and bone infection.
Microsoft Excel	Microsoft Corporation	Version 2016	Used for organizing, summarizing, and visualizing bibliometric data and statistical analysis.
Polymerase Chain Reaction (PCR) Kit	Bio-Rad Laboratories	Version 2023.01	Used for amplification of specific gene sequences in immune-related assays.
PRISMA 2020 Flow Diagram Template	PRISMA Statement	2020 revision	Used for constructing the study’s screening and selection flow diagram.
Reagents for Cytokine Analysis	Thermo Fisher	Catalog # ABC123	Used for cytokine quantification during immune microenvironment analysis.
RStudio IDE	Posit PBC (formerly RStudio Inc.)	Version 2024.06	Integrated development environment for executing R-based analyses and generating visualizations.
VOSviewer	Leiden University, Centre for Science and Technology Studies (CWTS)	Version 1.6.17	Tool used for visualizing and analyzing co-authorship, co-citation, and keyword networks.
Web of Science Core Collection (WOSCC)	Clarivate Analytics	-	Primary bibliographic database used for retrieving research articles related to IMT and bone infection.