Iliac crest donor site morbidity followi

50 %
50 %
Information about Iliac crest donor site morbidity followi
Science-Technology

Published on June 30, 2009

Author: AmrAlex

Source: authorstream.com

Iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty : Iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty Dr. Amr Osama Slide 2: amr_alex@msn.com Slide 3: amr_alex@msn.com Introduction : Introduction Best results of Autogenous bone grafting of Alveolar cleft achieved when the procedure is performed prior to the eruption of the permanent canine, in Europe it is Called ‘Secondary Alveolar Osteoplasty’ when it is done in the mixed dentition stage. Autogenous bone Sources can be used are : *Iliac crest (gold standard) *Calvarium *Mandibular Symphysis amr_alex@msn.com Slide 5: However some Authors have suggested that the iliac crest donor site produces an unacceptably high degree of morbidity such as : *Persistent Pain *Prolonged recovery time *Limping *Visible scarring *Bone contour deformities *Lesions of the lateral femoral cutaneous nerve as Meralgia Paraesthetica *Pelvic fracture *Peritonitis amr_alex@msn.com Slide 6: Hence the mandibular symphysis or Calvarium sites have been advocated recently because of morbidity at these donor sites should be considerably less than at iliac crest However among authors Canady et al.1993 concluded that iliac crest is a suitable site to harvest Cancellous bone for Alveolar Defect Grafting & should not be rejected solely because of concerns regarding excessive morbidity amr_alex@msn.com Minimal morbidity was aimed and achieved by many Surgeons : Minimal morbidity was aimed and achieved by many Surgeons 1984 Scott et al 1985 Caddy & Reid 1987 Shepard & Dierberg 1991 Thaller et al amr_alex@msn.com Slide 8: amr_alex@msn.com Scott et al. 1984 : Scott et al. 1984 Presented a closed method of procuring cancellous bone from the iliac crest with medium sized curette via a 2.5 cm incision successfully without complications in 150 cases, early ambulation was possible as muscle strapping was entirely eliminated amr_alex@msn.com Caddy & Reid 1985 : Caddy & Reid 1985 Described a similar technique for secondary alveolar reconstruction, they used a bone biopsy set to trephine cores of autogenous cancellous bone from illium, tested 1st in a cadaver and applied in 10 clinical cases The Author found superior results of easthetics and function compared with the conventional open osteoplasty method amr_alex@msn.com Thaller et al. 1991 : Thaller et al. 1991 used the same bone biopsy trephine in 24 patients ,it was to be performed as an out patient procedure and suitable in third world countries amr_alex@msn.com Shepard & Dierberg 1987 : Shepard & Dierberg 1987 Special osteotome for this purpose aiming to perform harvesting from iliac crest with minimum invasiveness using local anesthesia They noted the disadvantage in trephine devices of that time ,namely,that the bone graft was often left attached as the instrument was withdrawn .to solve this problem a cylindrical osteotome with luminal tines was developed inorder to separate the graft at the tip of the osteotome when it is rotated amr_alex@msn.com Cont . Shepard & Dierberg : Cont . Shepard & Dierberg Instrument set is composed of four parts, the first part is a Surface Cutter for the outer cortical bone and the other three parts are actual osteotomes with different diameters, the instrument is able to remove the bone cylinder of up to 5 cm length amr_alex@msn.com Operative Technique : Operative Technique A 2.5 cm incision over the iliac crest after local anesthesia taking care to inject beneath the periosteum ,the incision was made sharply down to the bone ,the mallet was then used to tap the cortex cutter about 0.5 cm into the bone to remove a small cortical disk of it . The cylindrical osteotome with appropriate diameter was then driven into the cancellous bone with a mallet A 90 degree twist of the instrument separated the rod of bone when the appropriate depth was achieved The cancellous bone cylinder was then extracted Several bone grafts may be harvested from the initial plug hole by varying the direction of the cylindrical osteotome , after sufficient bone had been harvested, the cortical bone disk was replaced and a standard wound closure was performed amr_alex@msn.com In 1995 : In 1995 Herald Eufinger in his department adopted the same technique of Shepard and Dierberg, and successfully used , The Aim of the study was to evaluate two different techniques of harvesting anterior iliac crest bone ,namely the Traditional open ostoeplasty and Closed technique Finally ,a modification of the instruments was described. amr_alex@msn.com Materials and Methods : Materials and Methods During the period 1993 to 1998, 52 patients with a unilateral or bilateral cleft lip alveolus and palate were operated on for reconstruction of alveolar process. Preoperative orthodontic transverse maxillary expansion and alignment of the teeth was completed all 52 patients received alveolar grafts from the anterior iliac crest In bilateral cases both sides were reconstructed simultaneously Half of these patients had their iliac bone harvesting performed with the open osteotomy and the remaining 26 patients underwent the closed harvesting method using the Shepard osteotome The study did not the graft success rate ,the graft resorption or tooth eruption at the recipient site ,instead operating time and technique postoperative pain medications ,subjective pain sensation ,complications, length and width of the mature scar, bone contour deficits and nerve paraesthesia were recorded allowing short-and long-term morbidity to be compared in both patient groups amr_alex@msn.com Traditional osteotomy Group : Traditional osteotomy Group Male to female ratio was 15:11 and the mean age was 9.6 yrs range from 7 to 20 yrs. 19 unilateral and 7 bilateral Bone harvesting performed under general anaesthesia Donor site was located on the anterior iliac crest, well behind the anterior superior iliac spine an incision was made, in the most cases lateral to the crest with minimal undermining The bone harvesting was carried out using an osteotome or an oscillating saw after the cartilage cap had been reflected medially or laterally. often a sharp spongiosa curettage would complete the procedure The sharp bony edges were smoothed and the crest cap was sutured back into position. finally haemostasis and closure with drains then dressing by pressure ,drains removed on the 1st or 2nd post operative days amr_alex@msn.com Slide 18: amr_alex@msn.com Slide 19: amr_alex@msn.com Closed osteotomy group : Closed osteotomy group 26 patients male-female 17:9 the mean age was 12.2yrs range between 8 to 31 years Unilateral to bilateral 21:5 The harvesting of bone done by the instrument tapping into the bone through a sufficient opening in the soft tissue. when more bone was required, the spongiosa cylinders were detached in an arc like fashion. Drains were hardly ever used and removed on the 1st post op. day and pressure dressing for 1 day. amr_alex@msn.com Slide 21: amr_alex@msn.com Slide 22: amr_alex@msn.com Slide 23: amr_alex@msn.com For both groups : For both groups Perioperative prophylactic Penicillin (or Clindamycin in case of penicillin allergy) Postoperative daily hip wound cleansing and removal of the skin sutures after approximately one week All patients were mobilized early ,mostly on the 1st day postoperative, discharged after 8-12 days Supporting physiotherapy was offered when needed Patients received pain relief on demand which consisted of Paracetamol 250 mg or 500 suppositories or pills amr_alex@msn.com Follow up : Follow up From 6 months to 1 year and the donor site morbidity was evaluated using 3 methods : 1-Questionnaire with a patient interview about the immediate postoperative donor site morbidity using scale from 1 to 6 mark 1 means pain free and mark 6 meaning extremely painful, the present hip morbidity was evaluated to obtain information about long-term morbidity and scaled also from 1 to 6 with 1 means very good, or normal compared to the non-operated site and 6 means worst possible ,the appearance of the hip wound was questioned using the same scale amr_alex@msn.com Cont. follow up : Cont. follow up 2- Mature scar length with unevenness ,color, bone contour and skin sensibility changes were recorded. Conspicuous and/or palpable bone deficits were noted 3- a survey of the patients files yielded details of diagnosis, operation date and time ,the manner by which the bone was obtained, intraoperative problems, blood loss ,wound closure ,use of drains early postoperative measures ,need for pain relief ,and supporting therapies Any complications were listed ,statistical analysis of numerical parameters obtained was performed using the unpaired (two-tailed) Student’s t-test amr_alex@msn.com Modifications : Modifications Did not use retractors to keep incision smaller Using 6 mm cortex cutter instead of 8 mm Used for both cortex cutting and bone harvesting Preferred not to replace the bone cap as it is used in grafting ,specially to support the nasal alar base amr_alex@msn.com Slide 28: amr_alex@msn.com Slide 29: amr_alex@msn.com Slide 30: THANK YOU amr_alex@msn.com

Add a comment

Related presentations

Related pages

Incidence of donor site morbidity following harvesting ...

Incidence of donor site morbidity following harvesting from iliac crest or RIA graft G.M. Caloria,*, M. Colomboa, E.L. Mazza a, S. Mazzolaa, E. Malagoli ...
Read more

Prospective Observational Study of Donor-Site Morbidity ...

In the iliac crest group, follow-up data were obtained for eighty-three patients (90%) at two weeks postoperatively, seventy-six (83%) at six weeks,
Read more

Iliac crest reconstruction to reduce donor-site morbidity ...

Iliac crest pain Donor-site morbidity Reconstruction Tri-calcium phosphate ... after posterior spinal arthrodesis: a minimum of 4-year follow-up.
Read more

Donor Site Morbidity After Minimally Invasive Anterior ...

Donor Site Morbidity After Minimally Invasive Anterior Iliac Crest Bone Graft Harvest
Read more

Iliac crest donor site morbidity in foot and ankle surgery

Iliac Crest Donor Site Morbidity in Foot and Ankle Surgery The authors retrospectively reviewed anterioriliac crest donorsite morbidityin 40consecutive ...
Read more

Donor site morbidity following iliac crest bone graft.

Donor site morbidity following iliac crest bone graft. ... CONCLUSION: Autogenous iliac crest bone grafting is associated with significant complications.
Read more

Palmer, Donor Site Morbidity Following Iliac Crest Bone Graft

iliac crest is the most common donor site because of easy ... Palmer, Donor Site Morbidity Following Iliac Crest Bone Graft.qxp Author: wimj Created Date:
Read more

Incidence of donor site morbidity following harvesting ...

Pain at the donor site at the 6-month follow-up was ... evaluated donor site morbidity and complication ... Iliac crest bone graft harvest donor site ...
Read more

Donor Site Morbidity After Anterior Iliac Crest Bone ...

Donor Site Morbidity After Anterior Iliac Crest ... Surveys were completed either by mail or follow ... Iliac Crest Bone Graft Harvest Donor Site ...
Read more