Abstract: Objective To evaluate the clinical efficacy of the Masquelet induced membrane technique in treating Wagner grade 3-4 diabetic foot with bone defect or osteomyelitis and compare the prognostic differences between patients with different Wagner grades.Methods Clinical data of 21 patients with Wagner grade 3-4 diabetic foot who underwent the Masquelet technique at Xiantao First People's Hospital from January 2022 to October 2024 were retrospectively analyzed,including 11 cases of Wagner grade 3 and 10 cases of Wagner grade 4.All patients underwent thorough debridement and antibiotic-loaded bone cement spacer implantation in the first-stage surgery,followed by autologous or composite bone grafting reconstruction within the induced membrane in the second stage.Limb salvage rate,deep infection control,bone healing,and wound healing were compared between the two groups.Perioperative indicators and functional recovery during follow-up were recorded,with a follow-up period of 12-18 months.Results The overall limb salvage rate was 85.7% (18/21),with 90.9% for Wagner grade 3 and 80.0% for Wagner grade 4 (P>0.05).The overall bone healing rate was 81.0% (17/21),with 90.9% in Wagner grade 3 and 70.0% in Wagner grade 4 (P>0.05).The bone healing time was (14.2±3.1) weeks,slightly shorter in grade 3 compared to grade 4 (P＞0.05).All wounds ultimately healed,with an overall wound healing time of (9.3±2.7) weeks.Recurrent infection occurred in 4 cases (19.0%),with no statistically significant difference between the two groups（P＜0.05）.Wagner grade 4 patients had significantly larger debridement range in the first stage and greater bone graft volume in the second stage compared to grade 3 (all P<0.05),but no significant differences were observed in hospitalization duration,complications,or functional recovery（P＜0.05）.Conclusion The Masquelet induced membrane technique is safe and feasible for Wagner grade 3-4 diabetic foot,achieving high infection control,bone reconstruction,and limb salvage rates.Although some prognostic indicators showed a negative trend in Wagner grade 4 patients,the overall differences were not significant,suggesting that this technique can serve as an important limb salvage strategy for severe diabetic foot under strict indication selection and comprehensive management.

Key words: masquelet induced membrane technique, diabetic foot, limb salvage