Long-term results at the donor site after free microvascular iliac crest transplantation (experience in 95 cases) and review of the literature

Abstract

The use of anterior iliac crest as donor site for free osseous, osteomuscular and osteomyocutaneous flaps has developed during the past decade into an important reconstructive instrument both in maxillofacial and in orthopedic surgery. Frequently published follow-up studies focus on reconstructive success evaluation and modification of the operative technique. A long-term retrospective evaluation of the donor site after vascularized free anterior iliac crest transfer is presented. The study is based on 95 cases from 1985–93 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Three percent developed hernias, loss of sensibility in the region of the lateral cutaneous femoral nerve occurred in 9.5%, but recovered in two-thirds. Seven percent of scars were unsatisfactory but no keloid or hypertrophic scars developed. All wounds healed primarily. Minor alteration in contour of the donor site was notable in 20–25% of the patients. Pain was a problem in an average of 7% of cases. Impairment in private life occurred in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases; 13.5% were dissatisfied with the situation of the donor site, while 12% of the interviewees were not satisfied with the preoperative information. Nonetheless, 98.8% of the patients were willing, if necessary, to undergo the same operation again.