Techniques and Complications of Bone Graft Harvesting

Abstract

Autogenous bone grafts are frequently harvested for the purposes of bone union and stability. Ilium is the most common site for bone-graft harvesting. Although some donor site complications may be unavoidable, awareness of the anatomy and complications may aid in planning the approach and minimizing the risks. A tricortical graft from the anterior ilium should be taken at least 2 cm posterior to the anterior superior iliac spine(ASIS). Iliac donor-site complications include pain, neurovascular injury, avulsion fractures of the ASIS, hematoma, infection, herniation of abdominal contents, gait disturbance, cosmetic deformity, violation of the sacroiliac joint, and ureteral injury. The neurovascular structures at risk for injury during iliac bone-graft harvesting include the lateral femoral cutaneous, iliohypogastric, and ilioinguinal nerves anteriorly and the superior cluneal nerves and superior gluteal neurovascular bundle posteriorly. Violation of the sacroiliac joint can be avoided by not penetrating the inner cortex. The caudal limit for bone harvesting should be the inferior margin of the roughened area anterior to the PSIS on the outer table to keep from injuring the superior gluteal artery. Strict observation of relevant anatomic considerations will help in avoiding these complications.