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Anterior Corticocancellous Graft Harvest

- See: Autograft Discussion

- Anterior Crest: Corticocancellous Graft:
    - position in the supine position with bump under the hip;
    - make an incision along the undersurface of the anterior crest, beginning about 2 cm posterior to the ASIS which continues a distance of about 7 cm;
           - avoid small incisions in obese patients;
    - determine desired thickness of the ICGB:
           - depending on the indications for the procedure, the surgeon may wish to obtain a thick corticocancellous graft or a thinner graft;
           - the anterior crest is thin for a distance of approximately 4 cm posterior to the ASIS, but more posteriorly it expands and thickness before becoming thin again in the mid-ilium;
           - a more anterior incision risks damage to the lateral femoral cutaneous nerve (which can result in meralgia paresthetica if the dissection is not performed carefully);
                   - in 10% of patients, the LFCN courses over the anterior crest of the ASIS (upto 2 cm posterior to the ASIS);
           - a more superior incision risks postoperative hernia formation;
           - an excessively posterior incision will expose the middle crest which is quite thin, contains little cancellous bone, and can be easily shattered;
                   - further, dissection along the middle crest risks injury to the iliohypogastric nerve;
    - after incising through the skin and the superficial subcutaneous tissue, the skin should be retracted superiorly inorder to allow the dissection to procede directly over the iliac crest;
           - this will minimize muscle dissection;
    - dissect down to the raphe joining the gluteal and abdominal musculature;
           - incise along this periosteal decussation at the supero-lateral aspect of the crest for an appropriate length;

- Bicortical Harvest:
    - bicortical grafts should be harvested at least 2 cm posterior to the ASIS, inorder to avoid fracture;

- Post Operative Care:
    - as noted by Sasso, et al (1998), there was no apparent advantage or disadvantage to use of drains for iliac crest donor sites;
    - reference:
           - Postoperative drains at the donor sites of iliac crest bone grafts.  A prospective randomized study of morbidity at the donor site in patients who had a traumatic injury of the spine.

Harvesting autogenous iliac bone grafts. A review of complications and techniques.

Fracture at the iliac bone graft harvest site after fusion of the spine.

Bone graft harvest site as a determinant of iliac crest strength.

A technique for obtaining bone graft.

Donor-site morbidity after harvesting rib and iliac bone.

A new technique for obtaining iliac bone grafts.

Procurement of Bone Graft from the Iliac Crest. An Operative Approach with Decreased Morbidity.

Cloward technique for obtaining iliac crest bone graft in hand surgery.

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