title: Is It Safe to Re-Harvest the Anterior Iliac Crest to Manage Le Fort I Interpositional Defects in Young Adults With a Repaired Cleft?
abstract: OBJECTIVE
  Re-harvesting the anterior iliac crest to obtain autogenous bone grafts is a controversial practice. The purpose of this study was to assess the feasibility and associated disability of re-harvesting the anterior iliac crest.
  
  
  METHODS
  To address the research purpose, the authors executed a retrospective case series study. The sample consisted of young adult patients with cleft (<26 yr old) with prior harvesting of the anterior iliac crest during mixed dentition for management of an alveolar cleft(s) and then re-harvesting of the same donor site for management of interpositional defects after Le Fort I advancement. Wound-healing parameters were reviewed at the donor and recipient sites. A survey questionnaire was provided after completion of treatment to document patient perception of early and any long-term donor-site disability. Descriptive statistics were computed for the variables.
  
  
  RESULTS
  The sample was composed of 27 patients with a mean age at re-harvesting of 17 years (range, 14 to 25 yr). Patients underwent on average 7.4-mm horizontal advancement, 2.4-mm lengthening, and 2.6-mm transverse expansion of the maxilla. Adequate bone graft was re-harvested to accomplish objectives in all cases. There were no perioperative complications at the donor or recipient sites. Twenty-six of the 27 patients (97%) had fewer donor-site recovery difficulties at the time of re-harvesting compared with the first time graft was taken. There were no cases of lateral femoral cutaneous nerve injury and no long-term discomfort with walking, running, or other activities.
  
  
  CONCLUSIONS
  The study confirms the safety and efficacy of re-harvesting corticocancellous bone from the anterior iliac crest for management of interpositional defects associated with Le Fort I advancement in young adults with a repaired cleft.
authors.affiliation: Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Department of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland, School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC. Electronic address: jposnick@drposnick.com.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Posnick
authors.affiliation: Surgical Fellow, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD.
authors.forename: James A
authors.initials: JA
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D064728:Alveolar Bone Grafting / Q000379:methods*; D001294:Attitude to Health; D064592:Autografts / Q000637:transplantation*; D016026:Bone Marrow Transplantation / Q000379:methods; D016025:Bone Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000601:surgery*; D008297:Male; D008437:Maxilla / Q000601:surgery*; D056948:Orthognathic Surgical Procedures / Q000379:methods; D019340:Osteotomy, Le Fort / Q000379:methods*; D017060:Patient Satisfaction; D010521:Periosteum / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012420:Running / Q000502:physiology; D012449:Safety; D020858:Tissue and Organ Harvesting / Q000379:methods*; D060053:Transplant Donor Site / Q000601:surgery*; D016138:Walking / Q000502:physiology; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult