Posterior Iliac Crest Bone Graft: How Much Is Enough?
Thaddeus Boucree1, Dylan McLaughlin, Silvy Akrawe
1*Department of Plastic and Reconstructive Surgery, Henry Ford Health Systems †Wayne State University School of Medicine, Detroit, MI.
The Journal of Craniofacial Surgery
|October 3, 2017
Summary
This study quantifies bone volume from the posterior iliac crest (PIC) for craniofacial reconstruction. Understanding PIC bone graft anatomy and variations improves surgical planning for mandibular defects.
Area of Science:
- Orthopedic Surgery
- Anatomy
- Oral and Maxillofacial Surgery
Background:
- Autogenous bone grafting is the gold standard for craniofacial defect reconstruction.
- The posterior iliac crest (PIC) is a common source for mandibular defect reconstruction using nonvascularized bone grafts.
- Accurate estimation of available bone graft volume is crucial for successful reconstruction.
Purpose of the Study:
- To provide an updated review of the dissection and quantification of bone volume that can be safely harvested from the posterior iliac crest.
- To identify anatomical variations in muscle insertion affecting PIC bone graft harvesting.
- To enhance surgical planning and management for craniofacial reconstructions.
Main Methods:
- Bilateral bicortical osteotomies were performed on 55 cadavers to obtain 110 PIC bone grafts.
- Demographic factors and bicortical osteotomy measurements (length, width, depth) were recorded.
- Anatomical variants of muscle insertion into the PIC were identified and documented.
Main Results:
- The average bicortical osteotomy volume was 40.6 cm³.
- Average osteotomy dimensions were 7.4 cm length, 5.5 cm width, and 1 cm depth.
- Two anatomical variants of muscle insertion were identified: latissimus dorsi/thoracolumbar fascia originating from the PIC (38%) or quadratus lumborum attaching to the PIC in its absence (62%).
Conclusions:
- This study provides precise measurements of PIC bone graft volume, aiding in accurate defect estimation.
- Identification of anatomical variants of muscle insertion is critical for safe and effective PIC bone harvesting.
- The findings facilitate improved surgical planning and patient management in craniofacial reconstruction.
