title: Comparison of minimally invasive versus conventional open harvesting techniques for iliac bone graft in secondary alveolar cleft patients.
abstract: BACKGROUND
  Autologous bone grafts, often harvested from the iliac crest, are the criterion standard for secondary alveolar cleft repair. The best technique for harvest remains controversial. Minimally invasive techniques have been used for bone graft harvest in cleft patients, but outcome studies have been limited by small numbers of patients.
  
  
  METHODS
  A total of 104 patients undergoing bone grafting for alveolar cleft were reviewed. Fifty-five consecutive patients underwent minimally invasive iliac bone graft harvest using the Acumed power-driven trephine system performed by the same surgeon. These patients were compared with 49 control patients undergoing a similar procedure in which the traditional method of open iliac bone harvest with an osteotome was used.
  
  
  RESULTS
  Operative time for the bone graft harvest was significantly shorter with the Acumed device when compared with the osteotome (2.37 hours versus 3.26 hours, p < 0.001). Patients who underwent minimally invasive Acumed bone harvest required significantly less postoperative analgesia than did patients who underwent osteotome harvest, for both narcotic (0.31 mg/kg versus 1.64 mg/kg, p < 0.001) and nonnarcotic (15.1 mg/kg versus 27.2 mg/kg, p < 0.01) pain medication. Acumed patients had significantly less pain on discharge (0.26 versus 3.1 pain scores on a scale from 0 to 10, p < 0.001) and left the hospital more quickly (23.3 hours versus 30.1 hours, p < 0.001).
  
  
  CONCLUSIONS
  Minimally invasive bone graft harvest technique using the trephine system offers a superior alternative to the conventional open iliac bone harvest method for patients undergoing secondary alveolar cleft repair, with shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New York, N.Y.; and Seattle, Wash. From the Institute of Reconstructive Plastic Surgery, New York University School of Medicine, and the University of Washington Medical Center.
authors.forename: Sheel
authors.initials: S
authors.lastname: Sharma
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Schneider
authors.forename: Jason
authors.initials: J
authors.lastname: Barr
authors.forename: Shahram
authors.initials: S
authors.lastname: Aarabi
authors.forename: Patricia
authors.initials: P
authors.lastname: Chibbaro
authors.forename: Barry
authors.initials: B
authors.lastname: Grayson
authors.forename: Court B
authors.initials: CB
authors.lastname: Cutting
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008437:Maxilla / Q000002:abnormalities* / Q000601:surgery; D008439:Maxillary Diseases / Q000151:congenital / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult