Donor Site Morbidities of Iliac Crest Bone Graft in Craniofacial Surgery

Abstract

Background The iliac crest bone graft (ICBG) is criticized for high donor site morbidity. Recent research suggests this morbidity is related to the patient population for which the ICBG is harvested. This systematic review is the first to delineate the type and incidence of ICBG donor site complications in craniofacial surgery. Methods Two independent reviewers conducted a systematic review of multiple databases (MEDLINE, EMBASE, CINAHL, PEDRO, and Cochrane Central Register of Controlled Trials) from 1917 to 2017. All studies utilizing the ICBG for craniofacial indications were included. Donor site morbidities, including immediate and chronic pain, hematoma, seroma, infection, hypertrophic/painful scarring, nerve injury, muscle herniation, iliac crest fracture, and gait disturbance, were recorded. A weighted incidence for each morbidity, excluding immediate pain, was calculated. An average visual analog scale score was calculated for immediate pain. Results Forty-four studies, with 2801 patients, were included. Oral and maxillofacial (50%) and cleft reconstruction (40%) were the primary indications for surgery. Average immediate pain visual analog scale scores on postoperative days 1 and 14 were 6.3 and 1.3, respectively. The incidence of donor site morbidities was as follows: acute (45.7%) and chronic (1.5%) gait disturbance, acute (17.8%) and chronic nerve changes (1.4%), hypertrophic/painful scar (9.1%), chronic pain (3.1%), hematoma (2.2%), seroma (2.0%), infection (1.0%), iliac crest fracture (1.2%), and muscle herniation (0%). Conclusions Chronic morbidity was lower than previously documented. Rare chronic morbidity illustrates that the ICBG remains a viable surgical option. The authors hope this review will facilitate surgical planning and informed consent.

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

“…We found delayed wound healing in 14 cases (2.89%) and unfavorable scar formation in 6 cases (1.24%), with no significant difference between the age groups. Here, our results were lower than those of Tosun et al, who detected hematoma in 8.1% and infection in 12.8% of cases [ 30 ], and also lower than those of Boehm et al, who described higher rates of hypertrophic and painful scars (9.1%) [ 29 ]. Therefore, the operation technique may have a greater impact on scar formation than age and its associated reduced skin elasticity.…”

“…While the overall rate of complaints after iliac crest graft procedures is generally low [ 18 , 23 , 28 ], gait disturbances are the most common morbidity [ 29 , 30 ], and yet, they are rarely chronic and seldom last a long time [ 2 , 17 ]. In our findings, 74 out of 485 patients suffered from this condition (15.26%), but only 11 patients (0.23%) had chronic gait problems that lasted for more than a month, which is lower than that described by Brudnicki et al [ 1 ] and Schaaf et al [ 23 ] and similar to that described by Nkenke et al [ 17 ].…”

3D Printing of Bone Grafts for Cleft Alveolar Osteoplasty – In vivo Evaluation in a Preclinical Model

“…A disadvantage of these bone grafts is the need of harvesting with associated donor site morbidity. In cases of maxillofacial and cleft reconstructions, the following rates of complications in the donor site region are summarized by a review of Boehm et al (2018): acute (45.7%) and chronic (1.5%) gait disturbance, acute (17.8%) and chronic nerve changes (1.4%), hypertrophic/painful scar (9.1%), chronic pain (3.1%), hematoma (2.2%), seroma (2.0%), infection (1.0%) and iliac crest fracture (1.2%). Against this background, it is of great clinical interest to evaluate biomaterials regarding their potential to be an alternative for the autologous bone grafts.…”

Topical Isoxsuprine in experimentally induced hypertrophic scar in rabbits

“…The areas of skin tension such as the chest, the back, and the upper arms are more prone to hypertrophic scar and keloid formation, and the areas of minimal skin tension such as the eyelids are less prone to hypertrophic scars and keloid formation. [5][6][7][8] Some systemic factors such as systemic hypertension have been to be associated with increased incidence of hypertrophic scar development. 9 Systemic inflammation is another recognized risk factor associated with both keloid and hypertrophic scar.…”