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Background The iliac crest bone graft (ICBG) is criticized for high donor site morbidity. Recent research suggests this morbidity is related to the patient population for which the ICBG is harvested. This systematic review is the first to delineate the type and incidence of ICBG donor site complications in craniofacial surgery. Methods Two independent reviewers conducted a systematic review of multiple databases (MEDLINE, EMBASE, CINAHL, PEDRO, and Cochrane Central Register of Controlled Trials) from 1917 to 2017. All studies utilizing the ICBG for craniofacial indications were included. Donor site morbidities, including immediate and chronic pain, hematoma, seroma, infection, hypertrophic/painful scarring, nerve injury, muscle herniation, iliac crest fracture, and gait disturbance, were recorded. A weighted incidence for each morbidity, excluding immediate pain, was calculated. An average visual analog scale score was calculated for immediate pain. Results Forty-four studies, with 2801 patients, were included. Oral and maxillofacial (50%) and cleft reconstruction (40%) were the primary indications for surgery. Average immediate pain visual analog scale scores on postoperative days 1 and 14 were 6.3 and 1.3, respectively. The incidence of donor site morbidities was as follows: acute (45.7%) and chronic (1.5%) gait disturbance, acute (17.8%) and chronic nerve changes (1.4%), hypertrophic/painful scar (9.1%), chronic pain (3.1%), hematoma (2.2%), seroma (2.0%), infection (1.0%), iliac crest fracture (1.2%), and muscle herniation (0%). Conclusions Chronic morbidity was lower than previously documented. Rare chronic morbidity illustrates that the ICBG remains a viable surgical option. The authors hope this review will facilitate surgical planning and informed consent.

Objective: To investigate parents’ understanding of the risks of primary cleft palate surgery after counseling with and without the use of a written informational aid. Design: Prospective, randomized, single-blind trial. Setting: Academic tertiary care center. Participants: Parents of children undergoing primary cleft palate surgery. Interventions: Parents were randomized to receive a standard informed consent discussion with or without provision of a written informational aid in the form of a pamphlet. Main Outcomes Measure: Parents’ recall of 9 specific surgical risks 3 weeks after informed consent discussion. Results: Forty parents enrolled in and completed the study (20 participants each in the control and intervention groups). There were no statistically significant differences between groups in terms of baseline demographics. The mean number of risks recalled were 3.7 (1.6) for the control group and 4.2 (1.9) for the intervention group (P = .37). The most commonly recalled risks were fistula formation and bleeding, while the least frequent were facial growth restriction and need for further surgery. No differences in risk recall were observed based on participant’s gender, level of education, or income. Conclusion: Parents of children undergoing primary cleft palate surgery recall less than 50% of counseled risks. The use of a written aid in the form of a pamphlet did not significantly improve recall in this sample. These results demonstrate that surgeons should implement additional measures to improve comprehension of surgical risks.

Background:Soft-tissue fillers are increasingly being used for noninvasive facial rejuvenation. They generally offer minimal downtime and reliable results. However, significant complications are reported and patients need to be aware of these as part of informed consent. The Internet serves as a vital resource to inform patients of the risks and benefits of this procedure.Methods:Three independent reviewers performed a structured analysis of 65 Websites providing information on soft-tissue fillers. Validated instruments were used to analyze each site across multiple domains, including readability, accessibility, reliability, usability, quality, and accuracy. Associations between the endpoints and Website characteristics were assessed using linear regression and proportional odds modeling.Results:The majority of Websites were physician private practice sites (36.9%) and authored by board-certified plastic surgeons or dermatologists (35.4%) or nonphysicians (27.7%). Sites had a mean Flesch-Kincaid grade level of 11.9 ± 2.6, which is well above the recommended average of 6 to 7 grade level. Physician private practice sites had the lowest scores across all domains with a notable lack of information on complications. Conversely, Websites of professional societies focused in plastic surgery and dermatology, as well as academic centers scored highest overall.Conclusions:As the use of soft-tissue fillers is rising, patients should be guided toward appropriate sources of information such as Websites sponsored by professional societies. Medical professionals should be aware that patients may be accessing poor information online and strive to improve the overall quality of information available on soft-tissue fillers.