Iliac crest donor site morbidity in foot and ankle surgery

Foot and ankle fusion is an important treatment for arthritis and deformities of the ankle and hindfoot. The literature has shown that there are improvements in fusion rates with the addition of bone graft and bone graft substitutes. Today autografts, specifically the iliac crest bone graft (ICBG), continue to be the gold standard despite significant donor site morbidity and nonunion rates, persisting around 10%. To address these drawbacks, bone graft substitutes have been developed. This article includes a historical review of the use, outcomes, and safety of autografts, allografts, and bone graft substitutes, such as ceramics, demineralized bone matrix, and platelet-derived growth factor.

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The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419849019 ◽

2019 ◽

Vol 4 (3) ◽

pp. 247301141984901 ◽

Cited By ~ 1

Author(s):

Jonathan R. Peterson ◽

Fangyu Chen ◽

Eugene Nwankwo ◽

Travis J. Dekker ◽

Samuel B. Adams

Keyword(s):

Bone Graft ◽

Donor Site ◽

Bone Grafts ◽

Bone Graft Substitute ◽

Autologous Bone Graft ◽

Donor Site Morbidity ◽

Foot And Ankle ◽

Level Of Evidence ◽

Ankle Surgery ◽

Bone Graft Substitutes

Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments. Level of Evidence: Level V, expert opinion.

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Donor site morbidity of calcaneal, distal tibial, and proximal tibial cancellous bone autografts in foot and ankle surgery. A systematic review and meta-analysis of 2296 bone grafts

Foot and Ankle Surgery ◽

10.1016/j.fas.2021.09.005 ◽

2021 ◽

Author(s):

Ahmed Khalil Attia ◽

Karim Mahmoud ◽

Kareem ElSweify ◽

Jason Bariteau ◽

Sameh A. Labib

Keyword(s):

Systematic Review ◽

Cancellous Bone ◽

Meta Analysis ◽

Donor Site ◽

Bone Grafts ◽

Donor Site Morbidity ◽

Foot And Ankle ◽

Ankle Surgery

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DONOR SITE MORBIDITY AFTER HARVESTING OF BONE FROM ANTERIOR ILIAC CREST FOR MAXILLOFACIAL RECONSTRUCTION

Egyptian Dental Journal ◽

10.21608/edj.2017.74734 ◽

2017 ◽

Vol 63 (1) ◽

pp. 263-269

Author(s):

Ahmed Naguib ◽

Khalid Saad ◽

Rafic Bedir

Keyword(s):

Iliac Crest ◽

Donor Site ◽

Donor Site Morbidity ◽

Maxillofacial Reconstruction

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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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Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

Foot & Ankle International ◽

10.1177/107110070502600302 ◽

2005 ◽

Vol 26 (3) ◽

pp. 191-197 ◽

Cited By ~ 15

Author(s):

Frederick J. Duffy ◽

James W. Brodsky ◽

Christian T. Royer

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Donor Site Morbidity ◽

Tissue Loss ◽

Soft Tissue Reconstruction ◽

Foot And Ankle ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Microsurgical Reconstruction ◽

Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

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Pain and Complications following Bone Marrow Aspirate Concentrate (BMAC) Harvested from the Iliac Crest in Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00146 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0014

Author(s):

Christy M. Christophersen ◽

Osama Elattar ◽

Daniel Farber

Keyword(s):

Bone Marrow ◽

Patient Satisfaction ◽

Bone Graft ◽

Iliac Crest ◽

Bone Marrow Aspirate ◽

Foot And Ankle ◽

Ankle Surgery ◽

Harvest Site ◽

Telephone Questionnaire

Category: bone graft in foot and ankle surgery Introduction/Purpose: Autologous bone is recognized as the gold standard for bone grafting in orthopedics with the iliac crest being the common harvest site. In an attempt to minimize morbidity associated with structural bone graft harvest from the iliac crest and still maintain the proposed benefit of collecting and transplanting live cells and growth factors, Bone Marrow Aspirate Concentrate (BMAC) obtained from the iliac crest has become increasingly popular. However, any harvest procedure can potentially induce pain and introduce complications. The purpose of this study was to evaluate the safety and complications of BMAC from the anterior iliac crest for use in various foot and ankle fusion procedures. Methods: A retrospective chart review was performed on all patients that underwent BMAC harvest from the iliac crest at the time of their foot or ankle surgical procedure by one of four fellowship trained surgeons between 2014 and 2017 with a minimum of six-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the BMAC harvest. The final outcome follow-up for the cohort was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31 to 81 years) and 69% were female. Results: Out of the 55 patients, 52 patients (94.5%) reported reported good to excellent results and were satisfied with the procedure at the time the questionnaire was conducted. Only 3 patients reported persistent complications and some element of dissatisfaction with the procedure after 6 months (the minimum follow up), 1 patient reported persistent numbness at the harvest site, and 2 reported some persistent pain at the harvest site lasting up to 6 months. Some patients reported transient complications that eventually resolved with no implication on their satisfaction of the procedure at the time of the telephone questionnaire. Four patients reported hematoma that was treated conservatively and eventually resolved spontaneously. Four patients reported transient numbness at the harvest site with eventual resolution. Immediately post-operatively, 50% of patients reported some element of post-operative pain. However, at the time of the final follow-up (at least 6 months), only 2 patients reported persistent pain at the harvest site lasting up to 6 months, but it was not considered activity-limiting pain. Conclusion: BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity with mostly self- limiting complications. This is the first study to evaluate the safety of BMAC as a part of foot and ankle surgical procedures.

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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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