Evaluation of long‐term functional donor‐site morbidity after deep circumflex iliac crest artery bone flap harvest

Background: In recent years, the composite anterolateral thigh free flap with tensor fasciae latae or vastus lateralis has been a new-applied type of flap that can provide very good reconstruction materials in complex defects of lower leg and foot. The study purpose is to evaluate the systematically complications of donor site, related factors to results of the donor area, in order to apply the result to improve the treatment, which have not been much reported in literature. Materials and Methods: Systematic donor site morbilidy evaluation in a prospective, uncontrolled clinical descriptive study of 33 composite anterolateral thigh free flaps in various forms to reconstruct anatomical structures or to resconstruct deep defects combined with covering the surfaces for complex soft tissue defects in lower extremities for 32 patients due to different causes in lower leg and foot area from 2014-2019 at Hue University of Medicine and Pharmacy. Examining and evaluating aesthetic and functional result of donor-site 3 months and 6 months up to 2 year after surgery; evaluating the correlation between the width and the type of the flaps and donor site closure methods. Result: In 33 composite flaps used, flap width to thigh circumference less than 20% in 27 cases (81.8%), more than 20% in 6 cases (18.20% ); There were 28 cases in which the donor site was directly closed, 5 cases required skin graft; All direct closed cases had flap width/ thigh circumference index below 20%; On the contrary, in cases having this index greater than 20%, the donor site required skin graft with p < 0.01. There are 11/33 (33.33%) of cases reported complications in donor site ; lateral thigh paresthesia is the most complicated complication with 8/33 cases (24.24%), followed by bad scarring 3/33 cases (9.09%). Conclusion: Long term follow up donor site morbility after composite anterior thigh free flap present 11/33 cases (33.33%): mostly complications of the donor site are thigh paresthesia with 8/33 cases (24.24%), and bad scarring 3/33 cases (9,09%), which improve time by time. Keywords: Composite anterior thigh free flap, lower extremities soft tissue defect, donor site morbidity

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Iliac crest donor site morbidity in foot and ankle surgery

The Journal of Foot & Ankle Surgery ◽

10.1016/s1067-2516(97)80064-6 ◽

1997 ◽

Vol 36 (2) ◽

pp. 155-158 ◽

Cited By ~ 24

Author(s):

S. David Schulhofer ◽

Lawrence M. Oloff

Keyword(s):

Iliac Crest ◽

Donor Site ◽

Donor Site Morbidity ◽

Foot And Ankle ◽

Ankle Surgery

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A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions

Journal of Neurosurgery ◽

10.3171/jns.1998.88.2.0255 ◽

1998 ◽

Vol 88 (2) ◽

pp. 255-265 ◽

Cited By ~ 268

Author(s):

Paul D. Sawin ◽

Vincent C. Traynelis ◽

Arnold H. Menezes

Keyword(s):

Comparative Analysis ◽

Iliac Crest ◽

Donor Site ◽

Wound Dehiscence ◽

Bone Grafts ◽

Fusion Rate ◽

Donor Site Morbidity ◽

Cervical Fusion ◽

Content Type ◽

Fine Print

Object. Autogeneic bone graft is often incorporated into posterior cervical stabilization constructs as a fusion substrate. Iliac crest is used frequently, although donor-site morbidity can be substantial. Rib is used rarely, despite its accessibility, expandability, unique curvature, and high bone morphogenetic protein content. The authors present a comparative analysis of autogeneic rib and iliac crest bone grafts, with emphasis on fusion rate and donor-site morbidity. Methods. A review was conducted of records and radiographs from 600 patients who underwent cervical spinal fusion procedures in which autogeneic bone grafts were used. Three hundred patients underwent rib harvest and posterior cervical fusion. The remaining 300 patients underwent iliac crest harvest (248 for an anterior cervical fusion and 52 for posterior fusion). The analysis of fusion focused on the latter subgroup; donor-site morbidity was determined by evaluating the entire group. Fusion criteria included bony trabeculae traversing the donor—recipient interface and long-term stability on flexion—extension radiographs. Graft morbidity was defined as any untoward event attributable to the graft harvest. Statistical comparisons were facilitated by using Fisher's exact test. Conclusions. Demographic data obtained in both groups were comparable. Rib constructs were placed in the following regions: occipitocervical (196 patients), atlantoaxial (35 patients), and subaxial cervical spine (69 patients). Iliac crest grafts were placed in the occipitocervical (28 patients), atlantoaxial (10 patients), and subaxial cervical (14 patients) regions. Fusion occurred in 296 (98.8%) of 300 rib graft and 49 (94.2%) of 52 iliac crest graft constructs (p = 0.056). Graft morbidity was greater with iliac crest than with rib (p < 0.00001). Donor-site morbidity for the rib graft was 3.7% and included pneumonia (eight patients), persistent atelectasis (two patients), and superficial wound dehiscence (one patient). Pneumothorax, intercostal neuralgia, and chronic chest wall pain were not encountered. Iliac crest morbidity occurred in 25.3% of the patients and consisted of chronic donor-site pain (52 patients), wound dehiscence (eight patients), pneumonia (seven patients), meralgia paresthetica (four patients), hematoma requiring evacuation (three patients), and iliac spine fracture (two patients). Even when chronic pain was not considered, morbidity encountered in obtaining iliac crest still exceeded that encountered with rib harvest (p = 0.035). The fusion rate and donor-site morbidity for rib autograft compare favorably with those for iliac crest when used in posterior cervical constructs. To the authors' knowledge, this represents the largest series to date in which the safety and efficacy of using autogeneic bone graft materials in spinal surgery are critically analyzed.

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Long-Term Results of Autologous Auricular Cartilage Graft Applied in Anophthalmic Orbits Unable to Wear Prosthesis

Journal of Ophthalmology ◽

10.1155/2019/7197063 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Yi-Lin Liao ◽

Shu-Ya Wu ◽

Yueh-Ju Tsai

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Long Term Results ◽

Chang Gung Memorial Hospital ◽

Cartilage Graft ◽

Auricular Cartilage ◽

Prosthesis Fitting ◽

Prosthesis Retention

In anophthalmic patients, shallow lower fornices make wearing ocular prostheses impossible and maintaining normal social activities difficult. This study retrospectively investigated the long-term surgical outcomes of autologous auricular cartilage grafting for contracted orbits. From 1995 to 2013, 29 anophthalmic contracture sockets with inadequate lower fornices and poor prosthesis retention presented to Chang Gung Memorial Hospital in Linkou, Taiwan, were treated using this surgical method. The success rate, aesthetic outcome, recurrence, and complications were analyzed. Among the 29 patients, 15 were women, 14 were men, their mean age was 45 years, and the mean follow-up time was 52 months (range = 6–159 months). Satisfactory lid position was achieved in 25 cases (86%), and lower fornix retraction recurred in four cases (14%). Neither donor site morbidity nor auricular deformity was noted during the follow-up period. Therefore, an auricular cartilage graft can be used successfully as a compatible spacer for anophthalmic patients with shallow lower fornices and prosthesis-fitting problems in long-term follow-up.

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Long-term donor-site morbidity after vascularized free fibula flap harvesting: Clinical and gait analysis

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2015.10.007 ◽

2016 ◽

Vol 69 (2) ◽

pp. 262-269 ◽

Cited By ~ 27

Author(s):

Damien Feuvrier ◽

Yoshimasa Sagawa ◽

Samuel Béliard ◽

Julien Pauchot ◽

Pierre Decavel

Keyword(s):

Gait Analysis ◽

Donor Site ◽

Donor Site Morbidity ◽

Free Fibula Flap ◽

Fibula Flap ◽

Free Fibula

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Effects of Sterilization Techniques and Culture Time on the Creep of Collagenous Ligament Analogues

Advances in Bioengineering ◽

10.1115/imece2002-32499 ◽

2002 ◽

Author(s):

Darryl A. Dickerson ◽

Kay C. Dee ◽

Glen A. Livesay

Keyword(s):

Cruciate Ligament ◽

Donor Site ◽

Critical Role ◽

The United States ◽

Donor Site Morbidity ◽

Joint Stability ◽

Acl Injuries ◽

Anterior Cruciate ◽

Active Patients

Every year, approximately 200,000 anterior cruciate ligament (ACL) injuries occur in the United States; of these cases, 60,000–75,000 patients undergo ACL reconstruction [1]. The ACL plays a critical role in knee stability; however, it possesses little inherent capacity for healing. Although reconstruction is often used in active patients, issues such as donor site morbidity and long term joint stability have motivated interest in tissue-engineered ligament analogues.

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Application of Trans-Areola Approach for Costal Cartilage Harvest in Asian Rhinoplasty and Comparison with Traditional Approach on Donor-Site Morbidity

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa012 ◽

2020 ◽

Vol 40 (8) ◽

pp. 829-835 ◽

Cited By ~ 1

Author(s):

Runlei Zhao ◽

Bailin Pan ◽

Hengju Lin ◽

Yan Long ◽

Yang An ◽

...

Keyword(s):

Traditional Approach ◽

Costal Cartilage ◽

Donor Site ◽

Donor Site Morbidity ◽

Main Concern ◽

Level Of Evidence ◽

Traditional Group ◽

Asian Patients ◽

Areola Approach

Abstract Background The traditional approach of harvesting costal cartilage through a chest wall incision can result in significant donor-site morbidity and usually causes notable scars in Asian patients. This has become the main concern for Asian females seeking rhinoplasty with autologous costal cartilage. Objectives The aim of this study was to investigate the donor-site morbidity of the trans-areola approach for costal cartilage harvest in Asian rhinoplasty and to compare it with the traditional approach. Methods Patients’ records were reviewed to determine whether their rhinoplasties had been performed with either the trans-areola or the traditional approach to costal cartilage harvest. Donor-site morbidity was evaluated 1 year postoperatively via a visual analog scale and the Modified Vancouver Scar Scale. Long-term complications of the trans-areola group were assessed at least 6 months after surgery. Results There were 26 females in the trans-areola group and 35 females in the traditional group; both groups were of similar age and body mass index range. Compared with the traditional group, the trans-areola group had a significantly longer surgery time and a higher pneumothorax rate (7.7% vs 2.9%) but a significantly better scar quality and a higher overall satisfaction. Long-term outcomes and complications of the trans-areola group included significant scars (2/26, 7.7%), concavity of the breast (1/26, 3.8%), and local chest pain/discomfort (1/26, 3.8%). Conclusions Compared with the traditional approach to harvesting costal cartilage in Asian rhinoplasty, patients who underwent the trans-areola approach had less overall donor-site morbidity and higher overall satisfaction. We recommend this technique to patients who meet the inclusion criteria as well as those seeking a better cosmetic outcome. Level of Evidence: 4

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A Comparison of Shepard's Osteotome versus Trapdoor Flap Technique to Harvest Iliac Crest Bone for Secondary Alveolar Bone Grafting

The Cleft Palate-Craniofacial Journal ◽

10.1597/06-235.1 ◽

2008 ◽

Vol 45 (4) ◽

pp. 347-352 ◽

Cited By ~ 8

Author(s):

J. Constantinides ◽

P. Chhabra ◽

P. J. Turner ◽

B. Richard

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Alveolar Bone ◽

Donor Site ◽

Donor Site Morbidity ◽

Iliac Crest Bone Graft ◽

Open Technique ◽

Flap Technique ◽

Graft Harvest ◽

Alveolar Bone Grafting

Objective: To compare the postoperative donor site morbidity and alveolar bone graft results following two different techniques for iliac crest bone graft harvest: a closed (Shepard's osteotome) and an open (trapdoor flap) technique. Design: A retrospective review of two cohorts of alveolar bone grafts performed from 1998 to 2004 in Birmingham Children's Hospital by two surgeons using different harvest techniques. Medical and nursing anesthetic notes and medication charts were reviewed. Alveolar bone graft results were assessed using preoperative and postoperative radiographic studies. Patients: A total of 137 patients underwent an operation. Of these, 109 patients were compatible with the inclusion criteria (data available, first operation, no multiple comorbidities). Sixty-four patients had iliac bone harvested using the open trapdoor technique, while 45 had the same procedure using the closed osteotomy technique. Results: Maximum bone graft volumes harvested were similar with both techniques. The mean length of hospital stay was 50.9 hours for the osteotome and 75.5 hours for the open technique group (p < .0001). The postoperative analgesia requirement was higher and the postoperative mobilization was delayed and more difficult for the open technique patients (p < .0005). Kindelan scores performed by two independent orthodontists were similar for both techniques. Conclusion: The findings demonstrate that harvesting bone from the iliac crest using an osteotome technique reduces time in hospital, analgesia requirements, and postoperative donor site morbidity with no detrimental outcome.

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