gms | German Medical Science

Objective: This retrospective study investigated the results of a minimally invasive method of anterior iliac bone grafting during a period of 5 years. Patients were clinically evaluated, their medical records were reviewed.

Methods: A maximum incision length of 40 mm is performed at the tip of the anterior iliac crest. The cortical bone is developed as a flap, the cancellous bone is removed with an ovally shaped curette especially developed for this method. The cortical flap and wound are closed, leaving a small scar and defect. In our retrospective analysis 46 patients from 2002 to 2007 could be reviewed. The patients were grouped according to gender and age at the time of operation and according to the procedure performed. All Patients were examined applying 3 major criteria: pain, lesions of the lateral femoral cutaneous nerve, and scar formation. To evaluate permanent lesions of the lateral femoral cutaneous nerve, the modified Dellon peripheral nerve score was applied. Pain was examined by applying the visual analogoue scale (VAS). Scar formation was evaluated by using the Manchester Scar Score. The patient’s medical records were reviewed for haematoma, infection, fracture and temporary lateral cutaneous femoral nerve lesions, dividing these complications into major events, e.g. those that necessitated return to the operating room and minor adverse effects, e.g. those that could be treated conservatively. The records were also reviewed for age, gender and main operative procedure performed.

Results and conclusions: Major and minor complications did not occur postoperatively. 7.4% of the patients complained of persistent pain, (3.7% VAS 3, 3.7% VAS 5.5) 92.6% were completely pain free (VAS 1). The mean scar length was 35 mm. 74.1% had a scar quality of 5 which means optimal scar formation, 3.7% reached a value of , 14.8% 7, 3.7% 6.The persistent pain was independent from scar length. Lesions of the lateral cutaneous femoral nerve were not recorded with the applied Dellon Score.Our results compare with the literature as follows: the postoperative pain is slightly better, scar length is considerably better. The non-existent lesions to the lateral cutaneous femoral nerve compare equally well with the literature. This is the first study to evaluate scar quality so pertaining literature cannot be consulted. With close to 75% of the patients having an optimal scar quality this procedure may be recommended for harvesting of small to medium amounts of cancellous bone.