title: Comparison of conventional surgery with motorized trephine in bone harvest from the anterior iliac crest.
abstract: 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.
authors.affiliation: The University of Toronto, Toronto General Hospital, The Hospital for Sick Children, Ontario, Canada. sandor_george@hotmail.com
authors.forename: George K B
authors.initials: GK
authors.lastname: Sàndor
authors.forename: Iain A
authors.initials: IA
authors.lastname: Nish
authors.forename: Robert P
authors.initials: RP
authors.lastname: Carmichael
mesh_terms: 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