Morbidity of iliac crest donor site in cleft lip and palate infants

The purpose of this study was to evaluate long-term morbidity associated with iliac crest bone harvesting at the age of 3–6 months. This bone was taken for early bony reconstruction in alveolar clefts. In 40 patients with an average follow-up of 6 years, no problems were noted by the parents. In 11 patients randomly subjected to clinical examination, muscle testing, joint mobility measurements, and gait analysis, there were no complications or abnormalities of any kind. Received: 3 February 2000 / Accepted: 11 May 2000     

Prospective study of iliac crest bone graft harvest site pain and morbidity

Background contextMorbidity associated with autologous bone graft harvest is an important factor in determining the utility of expensive alternatives such as recombinant bone morphogenic protein. The most frequently reported complication associated with graft harvest is chronic pain.PurposeTo prospectively determine the degree of pain and morbidity associated with autologous iliac crest bone graft harvest and its effect on activities of daily living.Study designProspective observational cohort study.Patient sampleOne hundred ten adult patients undergoing elective posterior lumbar spinal fusion surgery involving autologous iliac crest bone graft harvest.Outcome measuresPatient self-reported Visual Analog Scale (VAS) scores for pain and a study-specific questionnaire regarding activities of daily living.MethodsOne hundred ten patients were prospectively enrolled. Postoperative VAS scores (0–100) for harvest site pain were obtained at 6-week, 6- and 12-month follow-up. Patients completed a 12-month questionnaire regarding the persistence of specific symptoms and resulting limitation of specific activities.ResultsOne hundred four patients were available for 1-year follow-up. Mean VAS pain scores (scale 0–100) at 6 weeks, 6 and 12 months were 22.7 (standard deviation [SD], 25.9), 15.9 (SD, 21.5), and 16.1 (SD, 24.6), respectively. At 12 months, 16.5% reported more severe pain from the harvest site than the primary surgical site, 29.1% reported numbness, and 11.3% found the degree of numbness bothersome, whereas 3.9% were bothered by scar appearance. With respect to activity limitations resulting from harvest site pain at 1 year, 15.1% reported some difficulty walking, 5.2% with employment, 12.9% with recreation, 14.1% with household chores, 7.6% with sexual activity, and 5.9% irritation from clothing.ConclusionsThere is a significant rate of persistent pain and morbidity from iliac crest bone graft harvest when associated with elective spine surgery. Mean pain scores progressively decline over the first postoperative year. Nevertheless, harvest site pain remains functionally limiting in a significant percentage of patients 1 year after surgery. Rates of functional limitation are higher than previously reported and may be because of increased sensitivity of the prospective study design and targeted investigation of these specific symptoms. Validity of these findings is necessarily limited by patient ability to discriminate harvest site pain from alternative sources of back and buttock pain.     

Reduction of donor site morbidity of the iliac crest free flap by preservation of the anterior superior iliac spine

To reduce donor site morbidity in the iliac crest free flap, we suggest leaving the anterior superior iliac spine in situ. The advantages are: less tension on the wound, less pain, faster rehabilitation, preservation of the ability to wear pants without braces, and a better cosmetic result through preservation of contour. Received: 1 December 1999 / Accepted: 1 February 2000     

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting.     

Comparison of a modified minimally invasive with an open technique following harvesting of cancellous iliac bone

The open technique for obtaining cancellous iliac bone is often used for the repair of the cleft defects of the alveolus. However, recently a number of authors have stated that the morbidity and long-term cosmesis are unacceptable. The results of a long-term retrospective study of the donor sites in 47 patients who underwent the open technique are discussed. No major long term morbidity was found but a number of minor, troublesome symptoms were revealed in 36% including, itching, discomfort, hypertrophic scars and anaesthesia. The scar was considered unacceptable with a mean of 60 mm length and 4 mm wide. A minimally invasive technique is described that produces an adequate volume of milled bone, between 1.5 mls and 4 mls, (equivalent to 3–8 mls of unmilled bone). Discomfort was minimal postoperatively, and both gait and scar showed a highly favourable outcome. This unit is no longer employing the open technique for cancellous iliac bone removal.     

Results at the donor site after free microvascular iliac crest transplantation

The anterior iliac crest is used frequently as a donor site for free osseous, osteomuscular and osteomyocutaneous flaps in reconstructive maxillofacial and orthopedic surgery. A long-term retrospective study of the donor site after vascularized free anterior iliac crest transfer in 103 patients is presented. The patients were examined for objective complications and questioned about their subjective symptoms at the donor site. Objective and subjective results were then correlated: 2.8% of the patients developed hernias, 8.6% showed a loss of sensation in the area of the lateral cutaneous femoral nerve, which disappeared spontaneously in two-thirds of the patients, and 8.6% had unsatisfactory scars, but did not have hypertrophic scars or keloids. All wounds healed primarily. One fourth of the patients presented with minor alterations in the contour of the donor site, and 9.5% of cases had pain in the donor area. Impairment in private life occurred in 3.8%, in professional life in 4.8%, and in daily life in 12.3% of cases. Of the patients 13.3% were dissatisfied with the situation of the donor site, while 12.3% of those interviewed were not satisfied with the preoperative information they were given. Nonetheless, 98.1% of the patients would be willing to undergo the same operative procedure again, if necessary. Received: 9 March 1998 / Accepted: 14 April 1999     

脊柱前路手术髂前嵴取骨并发症相关分析

目的:探讨脊柱前路手术髂前嵴取骨的并发症发生情况。方法:回顾性分析2001年1月-2005年9月取髂骨行脊柱植骨融合术的154例患者,取骨部位均为髂前嵴,统计供骨区并发症,分析其相关因素。结果:术后随访时间均超过1年。28例(18.2%)患者发生不同程度的并发症,其中14例(9.1%)出现轻度并发症,12例(7.8%)出现中度并发症,2例(1.3%)出现重度并发症。127例(82.5%)患者接受了问卷调查,其中17例(13.4%)患者诉取骨处疼痛,疼痛自我感觉评分为1-6分(平均2分),其中3例(2.4%)患者需服用非甾体类抗炎药以减轻疼痛;7例(5.5%)患者诉取骨处有麻木感;无患者诉取骨处的疼痛及麻木感影响其日常活动;122例(96.1%)患者对供骨区切口外观满意。结论:髂前嵴取骨并发症中供骨区疼痛及麻木发生率较高,尤其是疼痛,应引起足够的重视。     

Postoperative pain following posterior iliac crest bone graft harvesting in spine surgery: a prospective,randomized trial

Background Context

Postoperative pain at the site of bone graft harvest for posterior spine fusion is reported to occur in 6%–39% of cases. However, the area around the posterior, superior iliac spine is a frequent site of referred pain for many structures. Therefore, many postoperative spine patients may have pain in the vicinity of the posterior iliac crest that may not in fact be caused by bone graft harvesting. The literature may then overestimate the true incidence of postoperative iliac crest pain.

Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients

Summary Background. Autologous anterior iliac crest bone graft is still widely considered the gold standard for anterior cervical fusion after discectomy or corporectomy. Postoperative pain at the donor site is one of the main disadvantages to this technique. This prospective study aimed to evaluate pain at the donor site, after careful, standardised bone harvesting. Methods. From March 2003 to March 2004, a prospective study was performed in a single neurosurgical department on 50 patients who underwent anterior iliac crest bone harvesting using a standard and careful surgical technique. During a one year follow-up, patient donor site pain was assessed with a Visual Analogous Scale (VAS) at 2, 7 and 60 days from surgery and finally, by a telephone interview, at one year. Findings. The duration of time in hospital ranged from 4 to 9 days. On the 2^nd day after surgery, pain, according to the VAS score, was recorded as being >7 by 4 patients (8%), 5–7/10 by 27 patients and >5/10 in 19 cases. On the 7^th day after surgery, none of the patients reported any VAS > 7, 1 patient’s VAS score was 6/10 and 49 patients had a VAS < 5. At 2 month follow-up, 45 patients were completely without pain (VAS 0) and the remaining 5 had a VAS < 5. At one year, 46 patients reported no pain (one patient was lost to follow-up); three continued to have pain <5 in VAS scale. Conclusions. After harvesting of bone from the iliac crest, using a standardised approach based on anatomised principles, most patients do not experience persisting pain at the donor site.     

Reconstruction of anterior iliac crest bone graft donor sites: presentation of a surgical technique

This study is a prospective evaluation of the reconstruction of anterior iliac crest bone graft donor sites using a technique developed by the authors. We present the technique and the initial results obtained with its use in 15 patients followed up for a period ranging from 6 to 16 months. Reconstruction of the iliac crest is performed using a rib, which is removed by an anterior approach to the spine. The rib is divided into two segments, which are fitted into the defect created in the iliac crest after removal of the bone graft. Clinical evaluation of the patients found a good cosmetic appearance of the reconstruction site, and the rib segments used showed good radiologic integration. Partial resorption of the segments was observed in two patients, with no effects on the cosmetic result. Received: 3 May 1999 Revised: 13 August 1999 Accepted: 18 August 1999     

Similar hypertrophy of a vascularized iliac crest and fibula bone graft for a tibial defect one decade later

Twenty years ago, priorities for vascularized bone grafts for segmental tibial defects were still ambiguous; and a battle for supremacy arose between the fibula and iliac crest as the donor site of choice. The fibula has since proved to be more versatile for larger defects, and this strong cortical bone has often been observed to undergo rapid hypertrophy in response to mechanical stresses. The long-term fate of vascularized iliac bone grafts (VIBG) is less well known, as this donor site is not commonly used today in this role. Thus, an unexpected return by our last patient with a VIBG more than a decade ago surprised us by his excellent result where unanticipated graft hypertrophy and remodeling approximated the appearance of the original tibia. When compared to a fibula bone graft performed at the same time, a similar long-term outcome was observed, suggesting that the iliac crest as a donor site for tibial defects may be more useful than heretofore appreciated. Received: 25 May 1999 / Accepted: 10 August 1999     

Morbidity associated with anterior iliac crest bone graft harvesting in children undergoing orthopaedic surgery: a prospective review

Purpose

Autologous iliac crest bone grafting is an integral part of many orthopaedic surgical procedures. Several studies have documented morbidity and prolonged pain following iliac crest bone graft harvesting in adults; however, in children there is a paucity of information. The purpose of the present study was to quantify the degree of pain and morbidity associated with anterior iliac crest graft harvesting in children undergoing non-spinal orthopaedic surgery.

Methods

Patients were prospectively enrolled prior to orthopaedic surgery. A patient self-reported visual analogue score was used to record pain at specified time points following surgery. In addition, the patients were reviewed at 2 and 6 weeks, 3 months and 1 year after surgery to record any complications.

Results

Data was collected on 33 patients (34 graft sites). Only one patient (2.94 %) had a complication, namely an injury to the lateral femoral cutaneous nerve. This resolved 3 months after surgery. 89 % of patients had no pain at the iliac crest graft harvest site 3 months after surgery. The three patients who had pain at 3 months had visual analogue scores of 1.0, 1.1 and 1.3, respectively.

Conclusion

This series reveals a very low complication rate and minimal iliac crest graft harvest site pain in children undergoing non-spinal orthopaedic surgery. In addition, the pain experienced is short-lived.     

Donor site morbidity following the harvesting of cortical bone graft from the tibia in children

Introduction  

Since the nature of complications following the harvesting of bone from the tibia in children is not well documented in the literature, we undertook this study in order to determine the frequency and nature of donor site complications following the harvesting of large cortical strut grafts from the tibial diaphysis in children.     

超声引导下腹横筋膜平面阻滞用于髂嵴前部取骨移植术的效果

目的 探讨超声引导下腹横筋膜平面(TFP)阻滞在髂嵴前部取骨移植术的应用效果。
方法 选择行髂嵴前部取骨移植术患者59例,男32例,女27例,年龄18～64岁,BMI 18～24 kg/m²,ASA Ⅰ或Ⅱ级。将患者随机分为两组：超声引导下TFP阻滞联合全麻组（T组,n=30）和常规全麻组（G组,n=29）。T组行超声引导下术侧TFP阻滞,G组不进行TFP阻滞。记录麻醉诱导前1 min、手术开始后1、10、30、60 min和手术结束时的HR、MAP和呼出气七氟醚浓度（C_ETSev）、术中芬太尼、瑞芬太尼和丙泊酚用量、拔管时间、PACU停留时间。记录术后4、8、12、24、48 h髂骨供区的静息和活动时VAS疼痛评分。记录PCIA总按压次数、有效按压次数、曲马多补救镇痛用量、补救镇痛和患者对髂骨供区镇痛的满意情况。
结果 与G组比较,手术开始后1、10、30 min T组HR明显减慢、MAP明显降低（P＜0.05）,手术开始后1 min至手术结束时T组C_ETSev明显降低（P＜0.05）;T组术中芬太尼、瑞芬太尼和丙泊酚用量明显减少（P＜0.05）,拔管时间和PACU停留时间明显缩短（P＜0.05）;T组术后4、8、12 h的静息和活动时VAS疼痛评分、术后PCIA总按压次数、有效按压次数、曲马多补救镇痛用量明显减少（P＜0.05）、补救镇痛率明显降低（P＜0.05）,患者对髂骨供区镇痛满意率明显升高（P＜0.05）。
结论 超声引导下TFP阻滞用于髂嵴前部取骨移植术麻醉和镇痛效果较好,有利于减少围术期麻醉镇痛药用量,血流动力学平稳,恢复快速,安全性高,患者满意度高。     

股前外侧皮瓣供区并发症的防治

目的 探讨临床应用股前外侧皮瓣的供区并发症及其治疗措施.方法 回顾性总结1988年7月至2007年7月,有效随访的427例施行股前外侧皮瓣手术供区的处理方法.其中:①直接缝合:单纯皮瓣49例,筋膜瓣27例;②游离植皮:单纯皮瓣258例;肌皮瓣65例;③逆行腹壁浅动脉皮瓣:28例.皮瓣或筋膜瓣切取面积30 cm×10 cm～18 cm×7 cm.随访时间8～54个月,平均21个月.采用SPSS 11.0.1对供区并发症进行统计学分析.结果 近期并发症(4周内)包括:植皮区皮肤坏死23例(5.4%),伤口感染17例(4.0%),肌肉坏死2例(0.5%);远期的并发症(6个月以上)包括:伤口迁延不愈21例(4.9%),严重瘢痕28例(6.6%),严重局部不适感25例(5.9%),股四头肌功能障碍16例(3.7%).统计分析表明供区手术方式与供区并发症的出现具有相关性,部分并发症之间存在相互影响.结论 应重视股前外侧皮瓣供区并发症的防治,合理选择和改良供区手术方案.术中注意软组织保护等均可有效预防和降低术后并发症的发生.供区采用股前外侧筋膜瓣移植或局部皮瓣转移修复供区是理想的选择.     

Analysis of relevant proteins from bone graft harvested using the reamer irrigator and aspirator system (RIA) versus iliac crest (IC) bone graft and RIA waste water

PurposeFemoral reaming using a Reamer Irrigator Aspirator (RIA) can produce greater than three liters of waste water per procedure, which contains cells and proteins that could promote bone healing. This purpose of this study was to determine the protein profile of RIA waste water and compare protein synthesis by cells harvested via RIA versus iliac crest (IC) bone graft.MethodBone graft was collected from 30 patients—15 using RIA from the femur and 15 harvested from the iliac crest. Waste water collected during the RIA procedure was analyzed in 12 patients. Cells from each graft were cultured in monolayer using growth media for 14 days and inductive media for the next 14 days. Media samples were collected on days 14, 21, and 28. Proteins for analysis were chosen based on their potential in bone healing, pro-inflammatory, and anti-inflammatory processes.ResultsProteins present in RIA waste water indicate the potential for clinical use of this filtrate as an adjunct for enhancing bone production, healing, and remodeling. Similarly, cells cultured from RIA bone graft harvests compared favorably to those from iliac crest bone grafts with respect to their potential to aid in bone healing.ConclusionRIA waste water has potential to serve as an autogenic and allogenic enhancer for bone healing. Continued development of processing protocols for viable commercial use of the waste water and pre-clinical studies designed to evaluate RIA waste water products for bone healing are ongoing.     

Proliferative and osteogenic differentiation capacity of mesenchymal stromal cells: Influence of harvesting site and donor age

Human mesenchymal stromal cells (hMSCs) are the cellular source of new bone formation and an essential component of autologous bone grafts. Autologous bone graft harvesting is routinely conducted at the iliac crest, although alternative donor sites with lower complication rates are available. Thus, the aim of this study was to compare hMSCs harvested from the iliac crest and the proximal tibia regarding their proliferative and osteogenic differentiation capacity. Furthermore, we investigated the influence of donor age on these biological properties.HMSCs were isolated from iliac crest or proximal tibia bone grafts of 46 patients. Proliferative capacity was assessed by cumulative population doublings, population doubling time, colony forming units and cell proliferation assays. Osteogenic capacity was assessed by quantification of extracellular calcium deposition and marker gene expression levels. The number of hMSCs per gram harvested tissue was determined. Furthermore, the adipogenic and chondrogenic differentiation capacity were quantified using BODIPY and Safranin Orange staining, respectively. Additional analyses were carried out after grouping young (18–49 years) and aged (≥50 years) donors.HMSCs derived from the proximal tibia featured a comparable proliferative and osteogenic differentiation capacity. No significant differences were found for any analysis conducted, when compared to hMSCs obtained from the iliac crest. Furthermore, no significant differences could be revealed when comparing young and aged donors. This was equally true for hMSCs from both donor sites after comparison within the same age group.Our study demonstrates comparable biological properties of hMSCs derived from both donor sites, the iliac crest and the proximal tibia. Furthermore, aging does not alter proliferative and osteogenic differentiation capacity. Consequently, the proximal tibia should be considered more closely as an alternative donor site in patients of all age groups.     

Femoral nerve palsy as a complication of anterior iliac crest bone harvest: Report of two cases and review of the literature

There are many documented neurological complications of anterior iliac crest bone harvest. Until now, these have included injuries to the iliohypogastric, subcostal and lateral femoral cutaneous nerves. Femoral nerve palsy as a direct surgical complication of anterior iliac crest bone harvest has never been cited in any surgical literature, although it has been reported in deep pelvic and abdominal surgeries in which improper retraction and/or prolonged hyperextension of the hip may have caused a nerve compression syndrome. In addition, surgical patients on antithrombolytic therapy have experienced hemorrhage within the iliacus and iliopsoas muscles, resulting in hematoma and secondary femoral nerve compression. The classic motor and sensory deficits reported in femoral nerve palsies are reduced or absent patellar reflex, weak hip flexion, quadriceps muscle weakness, and anesthesia of the anterior thigh and medial aspect of the leg. Two cases of femoral nerve palsy with different etiologies are presented.     

The concentration of calcium and phosphorus in trabecular bone from the iliac crest

Summary The concentrations of calcium and phosphorus were determined in central parts of bone trabeculae in the human iliac crest by means of an energy dispersive microanalysis technique. Two age groups, each consisting of six suddenly diseased male subjects, were investigated. It was found that the concentrations of calcium and phosphorus did not differ between young and old men. The obtained mean values were fairly alike and determined to 40 and 17 weight %, respectively.     

Long-term results at the donor site after free microvascular iliac crest transplantation (experience in 95 cases) and review of the literature

The use of anterior iliac crest as donor site for free osseous, osteomuscular and osteomyocutaneous flaps has developed during the past decade into an important reconstructive instrument both in maxillofacial and in orthopedic surgery. Frequently published follow-up studies focus on reconstructive success evaluation and modification of the operative technique. A long-term retrospective evaluation of the donor site after vascularized free anterior iliac crest transfer is presented. The study is based on 95 cases from 1985–93 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Three percent developed hernias, loss of sensibility in the region of the lateral cutaneous femoral nerve occurred in 9.5%, but recovered in two-thirds. Seven percent of scars were unsatisfactory but no keloid or hypertrophic scars developed. All wounds healed primarily. Minor alteration in contour of the donor site was notable in 20–25% of the patients. Pain was a problem in an average of 7% of cases. Impairment in private life occurred in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases; 13.5% were dissatisfied with the situation of the donor site, while 12% of the interviewees were not satisfied with the preoperative information. Nonetheless, 98.8% of the patients were willing, if necessary, to undergo the same operation again.