Clinical success in harvesting autogenous bone using a minimally invasive trephine.
OBJECTIVE
Autogenous bone grafting is well established for use in the maxillofacial skeleton. We present our experience with minimally invasive bone harvesting using a power-driven trephine, with favorable patient and clinical results.


METHODS
This retrospective study evaluation patients requiring autogenous bone harvested using a trephine, treated consecutively over a 3-year period. Mean patient age was 27.2 years (range, 8 to 77 years). Only those patients requiring elective surgery and admission on the same day were included in the study. Intraoperative assessment included the description of complications and the quantity and volume of the bone cores harvested. The complications monitored included bleeding, nerve injury, and perforation of the medial or lateral walls of the ilium. Postoperatively, patients were assessed for ambulation, pain, bleeding, and suitability for discharge. The patients were evaluated 1 week after surgery and were examined for wound complications (incision breakdown, infection, paresthesia, pain) and ambulatory deficits. All patients were then surveyed using a questionnaire outlining short-term (1 to 14 days), and long-term (>6 months postoperative) deficits, pain, and general remarks about the procedure.


RESULTS
A total of 84 patients underwent bone harvesting using a power-driven trephine. Bone was harvested from a total of 86 anterior iliac crest sites, for a total of 333 cores (3.96 cores per patient). Forty-one patients were discharged on the day of surgery. Intraoperatively, the volume of bone obtained ranged from 3 to 21 mL per harvest site (1 to 7 cores, 4 mm x 30 to 38 mm). The bone volume obtained was dependent on the size of the defect to be filled. Intraoperatively, 1 complication occurred (1 of 333 cores; 0.3%)-a broken instrument-and there were no perforations of the medial or lateral walls of the ilium or excessive bleeding. The complications totaled 3 (3.6%); none of these produced long term effects. Patients surveyed up to 6 months postoperatively noted positive results.


CONCLUSIONS
The harvesting of bone from the anterior iliac crest using a power driven trephine appears to be safe and results in minimal morbidity and ample bone volume for many maxillofacial procedures, without delaying discharge from hospital.
Sàndor
George K B
GK
Department of Oral and Maxillofacial Surgery, University of Toronto, The Toronto General Hospital at University Health Network, Toronto, Ontario, Canada. sandor_george@hotmail.com
Rittenberg
Brian N
BN
Clokie
Cameron M L
CM
Caminiti
Marco F
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D003762:Dental Instruments; D005260:Female; D005684:Gait; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*