Suitability of the Iliac Crest as a Site for Harvest of Autogenous Bone Grafts

1993 ◽  
Vol 30 (6) ◽  
pp. 579-581 ◽  
Author(s):  
John W. Canady ◽  
Deborah P. Zeitler ◽  
Sue Ann Thompson ◽  
Chris D. Nicholas
Keyword(s):  
Cancellous Bone ◽  
Postoperative Morbidity ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Bone Grafts ◽  
Autogenous Bone ◽  
Alveolar Bone Grafting ◽  
Patient Reported

Many donor sites have been advocated for obtaining cancellous bone to be used for grafting alveolar defects. Recently, some authors have suggested that the iliac crest site produced an unacceptably high degree of postoperative morbidity. Because of this morbidity, the use of other donor areas, e.g., rib, cranium, and mandible, are advocated. The iliac crest donor site for alveolar bone grafting has been common practice in our Institution for years under the assumption that little or no postoperative morbidity occurred. To investigate and document the accuracy of our assumption, the charts of the most recent 50 consecutive patients receiving alveolar bone grafts, all of which used the iliac crest as a donor site, were reviewed. Postoperative pain, numbness, infection, paralysis, or long-term disability were catalogued from the charts. In addition, a questionnaire was sent to the parents and patients requesting their perceptions of these parameters. In the cases reviewed, the average length of skin incision was 4.2 cm. The average quantity of bone harvested was 4.1 cc. The usual hospitalization time was 2–3 days. No patients experienced serious or long-term complications at the surgical donor site. Immediate postoperative complications among the 50 patients studied were limited to one hematoma, one stitch abscess, one case of swelling with pain, one erythema, and one 4-day fever accompanied by slight serosanguineous drainage. Information from the questionnaire suggests that most patients returned to full activity within 4–6 weeks. No patient reported any long-term pain or disability. We conclude that the iliac crest is a suitable site to harvest cancellous bone for use in alveolar defect grafting, and should not be rejected solely because of concerns regarding excessive morbidity.

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

2008 ◽  
Vol 45 (4) ◽  
pp. 347-352 ◽  
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.

Iliac Crest Donor Site for Children With Cleft Lip and Palate Undergoing Alveolar Bone Grafting

2016 ◽  
Vol 27 (3) ◽  
pp. 598-601 ◽  
Author(s):  
Jonathan Wheeler ◽  
Megan Sanders ◽  
Stanley Loo ◽  
Zac Moaveni ◽  
Glenn Bartlett ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Iliac Crest ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Donor Site ◽  
Alveolar Bone Grafting

Evaluation of Alveolar Bone Grafting: A Survey of ACPA Teams

2005 ◽  
Vol 42 (1) ◽  
pp. 99-101 ◽  
Author(s):  
Ananth S. Murthy ◽  
James A. Lehman
Keyword(s):  
North America ◽  
Cleft Palate ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
X Rays ◽  
Alveolar Bone Grafting ◽  
Missing Tooth

Objective To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. Design An anonymous survey was mailed to 240 American Cleft Palate– Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. Results Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. Conclusion There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.

Alveolar Bone Grafting: Donor Site Review of 100 Consecutive Cases in Cleft Lip and Palate

2017 ◽  
Vol 54 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Kavit Amin ◽  
Wee Sim Khor ◽  
Anais Rosich-Medina ◽  
Victoria Beale
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Iliac Crest ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Donor Site ◽  
Oral Morphine ◽  
Unknown Origin ◽  
Pyrexia Of Unknown Origin ◽  
Alveolar Bone Grafting

Objective Review of patients who underwent secondary alveolar bone grafting for total inpatient stay, postoperative complications, and postoperative analgesic requirements. Design Retrospective analysis of medical records. Setting Tertiary care center as part of a regional cleft lip and palate network. Patients All patients who underwent secondary alveolar bone grafting from the iliac crest. Interventions Local anesthetic was infiltrated overlying the anterior iliac crest. An incision was made to conform to the future skin crease and avoid muscle dissection. The cartilaginous cap was incised and raised, and cancellous bone was then harvested. The cavity was packed with hemostatic cellulose and closed in layers. All patients received postoperative antibiotics. All patients were prescribed regular paracetamol (acetaminophen) and ibuprofen if there were no contraindications. Oral morphine was available when requested. Main Outcome Measures Length of stay, postoperative analgesic requirements, and postoperative donor site and oral complications. Results From 100 consecutive patients, 92 (92%) of the patients were discharged the day after surgery; one (1%) patient required four nights of monitoring for postoperative pyrexia of unknown origin. All patients received regular paracetamol, and the majority (86%) did not require oral morphine. Complications included seroma (4%), superficial donor site abscess (1%), postoperative pyrexia of unknown origin (2%), gingival bleeding (2%), and oral infection (2%). Conclusion The findings suggest that donor site pain may be well controlled with simple, regular analgesia. Children tolerated this procedure well and were safely discharged the day after surgery. Alveolar bone grafting from the iliac crest was found to have low complication rates.

scholarly journals Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 759
Author(s):  
Marie Sophie Katz ◽  
Mark Ooms ◽  
Marius Heitzer ◽  
Florian Peters ◽  
Philipp Winnand ◽  
...  
Keyword(s):  
Wound Healing ◽  
Elderly Patients ◽  
Bone Graft ◽  
Postoperative Morbidity ◽  
Iliac Crest ◽  
Donor Site ◽  
Bone Grafts ◽  
Scar Formation ◽  
Delayed Wound Healing ◽  
Gait Disturbances

Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7–85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.

An Evaluation of Alveolar Bone Grafting in the UK and Ireland

2017 ◽  
Vol 55 (1) ◽  
pp. 57-63
Author(s):  
Preeti Jauhar ◽  
Thomas Macdonald ◽  
Brijesh Patel ◽  
Norman Hay
Keyword(s):  
Bone Grafting ◽  
Online Survey ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Poor Agreement ◽  
Alveolar Bone Grafting ◽  
Main Factors ◽  
The Uk ◽  
Good Agreement

Objective: To determine the main factors influencing the timing of alveolar bone grafting among cleft teams in the UK and Ireland, to assess the types of radiographs used to evaluate bone grafting sites pre- and postoperatively and the views of the profession on orthodontic expansion prior to grafting. Design: An online survey consisting of 24 questions was compiled and emailed to 53 orthodontists and surgeons in all 12 Cleft Hub Units in the UK and Ireland. Results: All units in the UK and Ireland responded with 51 responses, 39 complete and 12 partial responses, obtained from cleft surgeons and orthodontists. The majority of units are using dental criteria (75%) as a guide to timing alveolar bone grafting. Most units take a postoperative radiograph at 6 months but the view being taken varied. When asked if four cases were ready for grafting based on their radiographs, there was clear agreement by a significant majority for 3 cases but for 1 only a minimal majority (61%). The most common donor site chosen for the graft is the Iliac crest (92.9%). There was excellent agreement for 2 cases asking when to use expansion but poor agreement for one, 55% saying they would expand and 45% saying no. Conclusion: Overall there is good agreement among cleft teams in the UK and Ireland about management of alveolar bone grafting; however, a clearer consensus on preoperative orthodontic expansion may be needed.

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