Anterior Crest Harvest - Inner Table : Wheeless' Textbook of Orthopaedics

- See: Autograft Discussion

- Technique:
- the middle crest is quite thin and can be easily shattered;
- subperiosteaally, dissect the abdominal musculature and iliacus from the inner wall;
- after the tendinous decussation of the gluteal and abdominal muscles has been incised along the supero-lateral aspect of the crest, create two transverse periosteal incisions across the crest - at both ends of the incision;
- hence the periosteal incisions form three sides of a rectangle;
- one technique involves transversely cutting the iliac crest cap, a distance of 5 mm below the periosteal incision;
- using an osteotome, gently tap thru the medial cortex, preserving the perioteal and abdominal muscle attachments;
- this cap is then reflected medially;
- at this point cancellous bone can be harvested with currettes;
- alternatively, a periosteal elevator can be used to strip the ilacus off the inner table a distance of 5 cm;
- an osteotome is used to create two vertical incisions along the cortical surface of the inner table a distance of up to 5 cm;
- a right angled saw is used to complete the cortical windon;
- disadvantages:
- postoperative ileus may occur in some patients;
- ilioinguinal nerve (supplying sensation to the groin) runs along the medial surface of the iliacus muscle and can sustain a traction injury (neuropraxia) w/ excessive retraction;
- lateral femoral cutaneous nerve runs just below the ilioinguinal, and is also subject to neuropraxia;
- hernia formation: prevented by secure closure of abdominal fascia;