title: A comparison of Shepard's osteotome versus trapdoor flap technique to harvest iliac crest bone for secondary alveolar bone grafting.
abstract: OBJECTIVE
  To compare the postoperative donor site morbidity and alveolar bone graft results following two different techniques for iliac crest bone graft harvest: a closed (Shepard's osteotome) and an open (trapdoor flap) technique.
  
  
  METHODS
  A retrospective review of two cohorts of alveolar bone grafts performed from 1998 to 2004 in Birmingham Children's Hospital by two surgeons using different harvest techniques. Medical and nursing anesthetic notes and medication charts were reviewed. Alveolar bone graft results were assessed using preoperative and postoperative radiographic studies.
  
  
  METHODS
  A total of 137 patients underwent an operation. Of these, 109 patients were compatible with the inclusion criteria (data available, first operation, no multiple comorbidities). Sixty-four patients had iliac bone harvested using the open trapdoor technique, while 45 had the same procedure using the closed osteotomy technique.
  
  
  RESULTS
  Maximum bone graft volumes harvested were similar with both techniques. The mean length of hospital stay was 50.9 hours for the osteotome and 75.5 hours for the open technique group (p < .0001). The postoperative analgesia requirement was higher and the postoperative mobilization was delayed and more difficult for the open technique patients (p < .0005). Kindelan scores performed by two independent orthodontists were similar for both techniques.
  
  
  CONCLUSIONS
  The findings demonstrate that harvesting bone from the iliac crest using an osteotome technique reduces time in hospital, analgesia requirements, and postoperative donor site morbidity with no detrimental outcome.
authors.affiliation: Department of Plastic Surgery and Burns, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, UK. const-j@doctors.org.uk
authors.forename: J
authors.initials: J
authors.lastname: Constantinides
authors.forename: P
authors.initials: P
authors.lastname: Chhabra
authors.forename: P J
authors.initials: PJ
authors.lastname: Turner
authors.forename: B
authors.initials: B
authors.lastname: Richard
mesh_terms: D000543:Alveoloplasty; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002972:Cleft Palate / Q000601:surgery; D005260:Female; D006801:Humans; D007085:Ilium / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D010027:Osteotomy / Q000295:instrumentation*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods*