En Bloc Autogenous Fat Graft Harvest From the Anterior Iliac Crest

Background: Superior cluneal neuralgia (SCN) is an increasingly recognized yet still frequently overlooked cause of chronic lumbosacral and buttock pain. While historically attributed generally to iatrogenic iliac crest injury (bone marrow biopsy or bone graft harvest), more recently it is recognized as occurring in the absence of any trauma, with idiopathic entrapment resulting in compression neuropathy. Iliocostal impingement syndrome (IIS) is an even less commonly considered condition whereby the lower costal margin repetitively contacts and irritates the iliac crest, primarily occurring unilaterally and owing to severe scoliosis, but also in the context of severe vertebral column height loss. Case Report: We report here a case of an elderly woman with a 3-inch reported height loss over the decades who had suffered with chronic and intractable right lumbosacral and gluteal pain, and whom, on the basis of physical examination, we diagnosed presumptively with both SCN and with IIS as the underlying pathophysiologic mechanism. After undergoing successful diagnostic fluoroscopically guided superior cluneal nerve block, she was offered phenol denervation and enjoyed 9 months of reported 90% improvement in her symptoms, with gradual return to baseline over the next couple months. She has subsequently undergone repeat phenol denervation twice, with similarly good results. We believe this to be the first documented application of phenol neurolytic technique to SCN, and in the case of iliocostal impingement we argue that surgical release/resection or even peripheral nerve stimulation may not be effective owing to underlying compression/irritation diathesis from the inevitable pressure of the costal margin upon the iliac crest. Conclusion: In this case report, we also briefly summarize the current literature on SCN and compare phenol neurolysis to other therapeutic modalities. Key words: Superior cluneal nerves, neuralgia, iliocostal impingement, phenol, denervation

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Results of an Alternative Autogenous Iliac Crest Bone Graft Harvest Method

Orthopedics ◽

10.3928/01477447-20060401-15 ◽

2006 ◽

Vol 29 (4) ◽

pp. 342-346 ◽

Cited By ~ 17

Author(s):

Stephen C. Brawley ◽

R. Bruce Simpson

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Iliac Crest Bone Graft ◽

Graft Harvest ◽

Harvest Method

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Impact of Fat Graft Thickness and Harvesting Technique on Adipocyte Viability in a New Porcine Experimental Model: An Immunohistochemical Analysis

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa256 ◽

2020 ◽

Author(s):

Eduardo Gustavo Pires de Arruda ◽

Alexandre Mendonça Munhoz ◽

Walter Matsumoto ◽

Thiago Ueda ◽

Eduardo Montag ◽

...

Keyword(s):

Fat Grafting ◽

Fat Graft ◽

Large Animal ◽

Fat Necrosis ◽

En Bloc ◽

Experimental Medium ◽

Harvesting Technique ◽

Group I ◽

Perilipin A ◽

Hematoxylin And Eosin

Abstract Background Autologous fat grafting (AFG) has been employed in surgical practice as a filling method. However, controversies remain on the specifics of this technique. So far, few relevant experimental large animal studies have objectively assessed factors related to AFG integration. Objectives This study utilized an experimental, medium-sized animal model to compare the feasibility of AFG collected employing 2 different techniques with instruments of distinct thicknesses. Methods Twenty minipigs (Sus scropha domesticus) were subjected to AFG harvesting via en bloc resection utilizing 3- (Group I) and 5-mm-diameter (Group II) round punch blades (PBs) and liposuction (LS) with 3- (Group III) and 5-mm-diameter cannulas (Group IV). Both samples were grafted intramuscularly (biceps femoralis). Hematoxylin and eosin staining was employed to identify intact adipocytes, fat necrosis, fibrosis, inflammation, and oil cysts. Immunohistochemical staining (perilipin-A, tumor necrosis factor alfa, and cluster of differentiation number 31) was utilized to quantify the feasibility of adipocytes, tissue necrosis, and neoangiogenesis, respectively. Results Hematoxylin and eosin analysis showed that fat necrosis and histiocyte presence were significantly lower in the AFG harvested utilizing a PB than in LS. For perilipin-A, a statistical difference was observed between subgroups I and III (P = 0.001) and I and IV (P = 0.004). Instrument diameter had no effect on graft integration in comparisons between groups II and III (P = 0.059) and II and IV (P = 0.132). Conclusions In this experimental study, fat collected utilizing a PB demonstrated higher adipocyte viability than fat collected with LS. The diameter of the collection instruments, whether PB or LS, had no effect on graft integration.

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Odontogenic myxomas: what is the ideal treatment?

BMJ Case Reports ◽

10.1136/bcr-2018-228540 ◽

2019 ◽

Vol 12 (5) ◽

pp. e228540

Author(s):

Milad Tavakoli ◽

Raymond Williamson

Keyword(s):

Conservative Treatment ◽

Bone Graft ◽

Iliac Crest ◽

En Bloc Resection ◽

Bloc Resection ◽

Iliac Crest Bone Graft ◽

En Bloc ◽

Mesenchymal Neoplasm ◽

The Ideal

There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.

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Single-Stage Orbital Socket Reconstruction Using the Oversized Dermis Fat Graft and the 22 mm Silicone Orbital Implant after an Extended Enucleation

Case Reports in Ophthalmological Medicine ◽

10.1155/2018/8954193 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Biljana Kuzmanović Elabjer ◽

Mladen Bušić ◽

Daliborka Miletić ◽

Mirjana Bjeloš ◽

Borna Šarić ◽

...

Keyword(s):

Choroidal Melanoma ◽

Single Stage ◽

Long Term Results ◽

Fat Graft ◽

En Bloc ◽

Orbital Implant ◽

Absorbable Sutures ◽

Previously Treated ◽

Socket Reconstruction

We would like to present a surgical technique of orbital socket reconstruction using oversized dermis fat graft and 22 mm silicone orbital implant in a single-stage after extended enucleation in two patients with massive local recurrence of anteriorly located choroidal melanoma previously treated with endoresection. Orbital tissues en bloc were removed leaving conjunctival lining only at the fornices. Simultaneously, the 22 mm silicone sphere was implanted deeply into the orbit and covered with the oversized dermis fat graft of 30 mm in height and 35 mm in length with 20 mm of the fat thickness. The graft was sutured to the residual forniceal conjunctiva with interrupted 6/0 absorbable sutures overlapping conjunctiva with the graft edge for 2 mm to facilitate the epithelization. Epithelization was completed in two months, leaving well-formed fornices with good fitting of the prosthesis. The key point of orbital socket reconstruction after extended enucleation is to restore conjunctival lining prior to volume. Thus, whenever facing a massive volume and conjunctival lining loss, simultaneous insertion of the 22 mm silicone sphere deep into the orbit combined with oversized dermis fat graft is, in our opinion, the method of choice. It proved to be safe and effective with favourable long-term results.

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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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Trephine Technique for Iliac Crest Bone Graft Harvest

Spine ◽

10.1097/brs.0000000000003702 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Robert F. McLain ◽

Fernando Techy

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Iliac Crest Bone Graft ◽

Graft Harvest

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Surgical treatment of desmoplastic fibroma in the jaw using mandibular graft reconstruction – a case report

RSBO ◽

10.21726/rsbo.v15i2.624 ◽

2018 ◽

Vol 15 (2) ◽

pp. 130-04

Author(s):

Rafaela Savio Melzer ◽

Daniela Cristina Lunelli ◽

Cleverson Patussi ◽

Laurindo Moacir Sassi

Keyword(s):

Case Report ◽

Benign Lesion ◽

Bone Lesion ◽

En Bloc Resection ◽

Bloc Resection ◽

Desmoplastic Fibroma ◽

En Bloc ◽

Graft Harvest ◽

Long Term Follow Up ◽

Rare Benign Tumour

: Considered a rare benign tumour of fibroblastic origin, desmoplastic fibroma is an injury with aggressive behaviour and local recurrence and unclear aetiology, although trauma and genetic factors are considered. The pathology may develop in the femur, radio, pelvis and tibia, and rarely affects the jaws, characterized as an injury of slow asymptomatic growth that may vary radiographically. The local aggressive resection is the treatment of choice. Objective: To report a case of a desmoplastic fibroma in the mandible, whose treatment was en bloc resection followed by reconstruction with mandibular graft. Case report: Female patient, 33 years old, Caucasian, with a bone lesion discovered in routine x-ray. Images showed hypodense image with discrete destruction of bone cortical, near teeth 36 and 37, with no involvement of the roots. The chosen treatment was en bloc resection followed by reconstruction with mandibular graft harvest from ramus. Conclusion: desmoplastic fibroma is a benign lesion that should be included in the differential diagnosis list of osteolytic lesions. A long-term follow up is required, considering the potential to recurrence.

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