Complications of bone grafting mayoccur following a procedure of bone grafting.
Bone grafting is a very common procedure in orthopedics and iliac crest is currently the most common donor site.
Obtaining bone from the iliac crest can be associated with significant morbidity. Both the anterior and posterior portions of the iliac crest are often used for the purpose of bone grafting.
A review of the literature reveals following reported complications of bone grafting.
Superior gluteal artery injury is an infrequent but one of the severe complications of bone grafting in case of harvest of the posterior iliac crest. The cause of injury is usually excessive muscle retraction or the placement of retractors into the sciatic notch. When occur, these arterial injuries are difficult difficult to control, sometimes necessitating additional surgical exposure, including removal of the sciatic notch or an anterior or retroperitoneal surgical approach. The vessel may be controlled by an angiographic embolization method too.
Sometimes, injuries to the superior gluteal artery also manifests late as a gluteal artery aneurysm.
Patients with postoperative hematuria, abdominal distention, ileus, and fever should be assessed for genitourinary tract injury. The ureter is closer to the superior gluteal artery and the sciatic notch in women, special attention be given to protection of the sciatic notch when a graft is harvested from the posterior iliac crest in a female patient.
Herniation of the abdominal contents through the donor site defect is a relatively common complication. Patients may present with lower abdominal pain and a sensation of fullness in the donor site.
Computed tomography usually clearly shows the hernia. Advanced age, obesity, female sex, and a graft larger than 4 cm.
Local tissue closure, Bosworth’s method of crest resection and closure, rotation of regional fascial flaps, and the use of synthetic mesh grafts have all been suggested to treat these defects.
Chronic Pain and Nerve Injuries
Chronic pain after il is one of the more common complications of bone grafting reported.
Most cases probably result from occult nerve injury or destabilization of the muscular origin at the time of harvest.
Chronic alteration in donor site sensation is one of the most commonly reported complications of bone grafting from iliac crest.
Injury to the superior clunial nerves has been reported at the time of posterior iliac crest bone harvest.Patients with injuries to the clunial nerves have posterior pelvic pain radiating into the buttocks that is often made worse by sitting. Often these injuries can be treated with sequential nerve blocks and desensitization and occasionally necessitate exploration and neuroma resection.
Meralgia paresthetica may occur due to injury to the lateral femoral cutaneous nerve may occur after or occurs after harvest of the bone from the anterior iliac crest. Symptoms improve with occasional nerve blocks, analgesics, and desensitization. Some patients may require operative decompression or nerve sectioning.
Ilioinguinal nerve is vulnerable to injury due to medial retraction in this area resulting in loss of sensation to the pubic symphysis, base of penis and proximal scrotum or labia majora, and the anteromedial aspect of the thigh.
Like any other surgical procedure, donor site wound may get infected and needs treatment to control infection.
Fractures after iliac crest bone harvesting occur during harvesting anterior parts of the iliac crest. Most often, the fracture results in displacement of the anterior superior iliac spine. Treatment is usually nonoperative and focuses on a short period of rest followed by assisted ambulation until the fracture heals. Occasionally surgical treatment may be required.
Removal of the superior surface of the ilium or to the development of an unsatisfactory scar. Current recommendations are to use methods that preserve superior pelvic brim like removal of a section of ilium below the crest, superior crest trapdoor and crest splitting methods.
Significant hematoma after iliac crest bone grafting has been reported in up to 10% of cases.
There aree reports of musculoskeletal tumors being transplanted between two distant surgical sites.
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