Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis

Antonio Barone, Massimiliano Ricci, Francesco Mangano, Ugo Covani
Journal of Oral and Maxillofacial Surgery 2011, 69 (9): 2298-304

PURPOSE: The iliac crest provides an important donor site for cancellous, cortical, and corticocancellous bone because it has the highest concentration of osteocompetent cells, offers sufficient volume, and is readily accessible. Although iliac crest harvesting is considered a common procedure in different medical specialities, donor site morbidity is a subject that requires further discussion. Moreover, the increasing number of bone grafts being undertaken stresses the importance of donor site morbidity in surgical planning and for patient consent. This study evaluated morbidity associated with iliac crest harvesting over a 10-year period and patients' overall satisfaction.

MATERIALS AND METHODS: This prospective study involved 235 patients who were scheduled for iliac harvesting procedures from April 2001 through May 2010. A standardized surgical procedure with an anterior approach was used for the harvesting of all iliac crest grafts. The following variables were considered: pain, discomfort, presence of functional disorders, presence of sensory disturbances, esthetic outcome, and patients' general satisfaction, which were evaluated using specific tests or questionnaires.

RESULTS: Ninety-nine percent of patients complained of mild pain 1 week after intervention but the pain rapidly disappeared after a few weeks. Functional disorders such as alterations in walking and lifting strength were reported by 100% of patients after intervention, but after 5 weeks this percentage had decreased substantially. Sensory disturbances such as hypoesthesia were recognized as transitory complications of iliac crest harvesting. A large percentage of patients were satisfied with the esthetic outcome of the intervention.

CONCLUSIONS: Although the anterior iliac crest is a donor site with low morbidity, many studies have reported contrasting results. These data support the idea that the surgical approach plays a crucial role in decreasing postoperative morbidity. Moreover, this study confirmed that the anterior iliac crest can be considered a first-rate option for bone-defect reconstruction because of its low morbidity. However, future improvements in bone substitutes may well change this situation.

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