Evaluation of long‐term functional donor‐site morbidity after deep circumflex iliac crest artery bone flap harvest

Rendenbach, Carsten; Goehler, Friedemann; Hansen, Lara; Kohlmeier, Carsten; Amling, Michael; Hanken, Henning; Beck‐Broichsitter, Benedicta; Heiland, Max; Riecke, Björn

doi:10.1002/micr.30358

Cited by 19 publications

(15 citation statements)

References 29 publications

(48 reference statements)

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“…In their study, there were no impairments of daily life activities in the long term, with a low impact of decreased joint mobility in patients' daily life. 50 In our series, the ASIS was always preserved. Due to the accurate CAD/CAM planning and using the 3D guides and models, precise amounts of iliac crest are used, making it possible to easily preserve the ASIS.…”

Section: Preservation Of the Asismentioning

confidence: 57%

The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era

Hilven

Vranckx

2021

J Reconstr Microsurg

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Background The iliac crest bone flap (ICBF), based on the deep circumflex iliac artery, has a bad reputation regarding donor site morbidity. However, the ICBF has an ideal curvature and shape for occlusion-based hemimandibular reconstructions with rapid dental rehabilitation and for vertical class III maxillary reconstructions that require bony support and muscular bulk to fill cavities and to provide intraoral lining. Is this notorious donor site reputation still valid with modern flap procurement using computer aided design/computer aided manufacturing (CAD/CAM) and recipient-site closure techniques? Materials and Methods We performed a literature search of the public databases PubMed, Cochrane, Google Scholar, and Web of Science for papers using mesh keywords related to donor site morbidity of the ICBF. We report three illustrative case reports using our current protocols for oncologic bony resection and reconstruction, using in-house CAD/CAM and three-dimensional printing to procure a tight-fit ICBF and minimizing donor site morbidity. Results We found 191 articles in the PubMed database of which we considered 176 nonrelevant. Cochrane Library and Google Scholar database searches resulted in the inclusion of 11 additional papers. The second search resulted in 172 articles of which we used five after excluding nonrelevant papers. Accurate preoperative (CAD/CAM) planning, preservation of the anterior superior iliac spine (ASIS), and paying attention to thoroughly donor site closure make the ICBF a very valuable option for accurate maxillofacial reconstructions with very acceptable comorbidities. This corresponds with our clinical findings. Conclusion Dogma never is a good teacher; it remains elementary that routine “knowledge” is (re)questioned. Donor site morbidity of the ICBF is comparable to other bone flaps. The shape and bone stock of the ICBF is ideal and often may be first choice. In combination with CAD/CAM planning, the ICBF is an excellent option for specific maxillofacial reconstructions.

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Section: Preservation Of the Asismentioning

confidence: 57%

The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era

Hilven

Vranckx

2021

J Reconstr Microsurg

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“…This can be supported by a study by Rendenbach et al who reported that harvest of DCIA flaps may lead to restricted mobility of the hip joint in all the three planes secondary to the muscle guarding. 21 Hence it is essential to restrict the quantum of graft harvest to avoid untoward complications in paediatric population. Restricting the quantum of graft harvest to 50% of the volume available by preoperative CT evaluation, respecting the anatomical constraints of the Pediatric hip bone, maintaining the integrity of the cortical shell are essential to avoid these untoward complications.…”

Section: Discussionmentioning

confidence: 99%

Quantum of cortico-cancellous bone safe for harvest from anterior iliac wing of pediatric patients: a finite element analysis with clinical correlation

2020

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Background: Objective was to assess the maximum quantum of cortico- cancellous bone that can be harvested from the Anterior Iliac Wing (AIW) of paediatric population.Methods: All patients reporting to the unit for the correction of bilateral cleft alveolus were included. A Computed Tomogram (CT) of the hip was recorded and the volume of cancellous bone available for harvest was assessed. Finite element model of the hip was generated using D2P and Geomagic Free form software and the impact of bone harvest on stress distribution along the anterior iliac wing was assessed by substituting the muscle forces (hip abductors and sartorius group) and was clinically correlated to volume harvested and donor site morbidities.Results: 10 patients were enrolled, 5 patients were excluded. CT volumetric evaluation revealed an average 0.5 cc to 4.7 ccof cancellous bone and 6.7 cc to 11 cc of cortical bone was available for harvest. Harvest of 50% of available graft volume was safe with minimal stress distributed along the line joining the tuberosity to the area between Antero Superior and Inferior spines (4.2 MPa at rest and 18.5 MPa at stance). The stress levels increased with increase in volume of bone harvested. Intra operatively 1.9 cc to 6.2 cc of cortico cancellous graft was harvested, which was equivalent to 60% of the graft available with no long-term morbidities.Conclusions: The volume of bone graft harvest should be restricted (up to 6 cc) to avoid long term morbidities.

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“…Further studies showed the high incidence of chronic pain in up to one third of iliac crest bone graft patients (Ropars et al, ; Skeppholm & Olerud, ). Rendenbach et al () recently analyzed the donor site morbidity after deep circumflex iliac crest artery bone flap harvest in 14 patients. The found a reduction in mobility of the hip joint and the lumbar spine, along with restrictions in standing up from a bent position and sensory deficits.…”

Section: Discussionmentioning

confidence: 99%

Donor site morbidity of vascularized bone grafts from the medial femoral condyle for osseous revascularization

et al. 2019

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Background Vascularized bone grafts from the medial femoral condyle (MFC) are used to gain surgical revascularization of osseous defects. To date objective data regarding the donor site morbidity are limited. This study aims to evaluate the donor site associated outcome after MFC flap harvest. Patients and Methods From 2008 to 2016, 22 patients who underwent MFC bone flap harvest for osseous revascularization of 9 talus, 8 scaphoids, 2 metacarpals, 1 phalanx, 1 pilon tibiale, and 1 distal femur were included. Outcome analysis was performed for the whole cohort as well as for two subgroups (recipient site upper [group A] and lower extremity [group B]) by the lower extremity functional scale (LEFS), the OAK‐score of the Swiss Orthopedic Society and the visual analog scale (VAS). Additionally, a 3D gait analysis was performed for four patients. Results The mean flap size was 1 × 1 × 3 cm. No flap loss was observed. One minor surgical revision was performed due to donor site hematoma. Mean follow‐up was 35.8 (12–98) months. Mean LEFS‐score was 74.9 ± 9.5 (A: 74.3 ± 7.9; B: 75.6 ± 11.2, p > .05) and OAK‐score was 92.8 ± 9.4 (A: 93.2 ± 5.8; B: 92.4 ± 12.3, p > .05). At follow‐up examination, pain at rest was stated with 0.1 ± 0.2 (A: 0.1 ± 0.3; B 0 ± 0, p > .05) and with activity 0.6 ± 1.4 (A: 1.2 ± 1.8; B: 0 ± 0, p > .05) on VAS. The 3‐D gait analysis showed normative walking patterns. Conclusion After MFC flap harvest knee function and gait pattern were almost unimpaired. Donor site morbidity can be considered as being of minor concern in the decision‐making for this microvascular procedure.

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Evaluation of long‐term functional donor‐site morbidity after deep circumflex iliac crest artery bone flap harvest

Abstract: Functional donor site morbidity after DCIA harvesting can be expected to be low in the long-term.

Cited by 19 publications

References 29 publications

The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era

The Iliac Crest Osteomuscular Flap for Bony Reconstruction: Beast or Beauty? A Reassessment of the Value and Donor Site Morbidity in the CAD/CAM Era

Quantum of cortico-cancellous bone safe for harvest from anterior iliac wing of pediatric patients: a finite element analysis with clinical correlation

Donor site morbidity of vascularized bone grafts from the medial femoral condyle for osseous revascularization

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