Comparison of conventional surgery with motorized trephine in bone harvest from the anterior iliac crest.
OBJECTIVE
A prospective study was performed to compare morbidity associated with the harvest of corticocancellous block grafts (CCBG) by conventional surgery and procurement of cancellous cores (CC) by means of a motorized trephine from the anterior ilium.


METHODS
Seventy-six patients requiring 30 mL or less of cancellous bone for maxillofacial reconstruction were placed into 2 treatment groups. One group underwent harvest of CCBGs in the traditional open medial approach to the anterior ilium. The second group had CCs harvested through a 0.5- to 1.0-cm incision with a motor-driven trephine. The following parameters were used to evaluate patient morbidity: number of days to unassisted ambulation, length of hospital stay, and pain scores for both the recipient and the donor sites.


RESULTS
The mean time to patients' unassisted ambulation following a CCBG was significantly longer (2.8 days) than following CC (0.8 days). The mean length of hospital stay following a CCBG was significantly longer (4.1 days) than following a CC (2.2 days). The mean contemporaneous maxillofacial pain scores following procurement of CCs (day 1: 5.6; day 3: 4.2) and procurement of CCBGs (day 1: 5.8; day 3: 4.5) were not significantly different, whereas the mean hip pain was significantly greater (P <.05) on day 1 in patients having undergone a CCBG (pain score: 6.2) than in patients having undergone a CC graft (pain score: 3.0). Gait disturbance was identified in 15 of 22 patients (68%) who underwent a CCBG. Only 1 of the 54 patients (1.9%) who underwent a CC graft exhibited an abnormal gait. No other complications were noted. The results demonstrated a significant difference in morbidity between the 2 techniques in all variables.


CONCLUSIONS
Where modest amounts of cancellous bone are required for maxillofacial grafting, trephining of cancellous cores results in significantly less morbidity than traditional open methods.
Sàndor
George K B
GK
The University of Toronto, Toronto General Hospital, The Hospital for Sick Children, Ontario, Canada. sandor_george@hotmail.com
Nish
Iain A
IA
Carmichael
Robert P
RP
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005684:Gait; D006801:Humans; D007085:Ilium / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods*; D016138:Walking