Complication Rates of the Anterior Iliac Crest Bone Graft Donor Site for 426 Pediatric Patients Undergoing Alveolar Bone Grafting.

Abstract

Background: The iliac crest bone graft (ICBG) has long been considered the gold standard for secondary alveolar reconstruction in patients with cleft lip and palate. With the advent of grafting alternatives, such as bone morphogenetic protein-2, the morbidity of the iliac crest harvest has come into question.

Purpose: The purpose of this study is to estimate the frequency, types, and identify risk factors for postoperative complications of the anterior ICBG hip donor site.

Study design, setting, sample: A retrospective cohort study of patients who received alveolar reconstruction with anterior ICBG by 2 surgeons over an 11-year period at the Children's of Alabama Hospital in Birmingham, Alabama, was conducted. Exclusion criteria included previous alveolar graft attempt, age greater than 18 years at the time of repair, or lack of postoperative follow-up.

Predictor variable: The predictor variable was a set of risk factors associated with complications and included sex, age at surgery, and cleft type (unilateral vs bilateral).

Main outcome variable: The main outcome variable was donor site morbidity defined as the presence of complications, prolonged length of stay, or readmission. Complications included gait disturbance, transient hypoesthesia, and hypertrophic scar.

Covariates: Covariates included length of follow-up and alveolar cleft graft timing (secondary vs tertiary).

Analyses: Descriptive and bivariate analyses were completed. The level of statistical significance was P < .05.

Results: The sample size was composed of 426 subjects with a mean age of 7.9 ± 2.3 years. Of the total subjects, 211 (49.5%) patients were male and 215 (50.5%) patients were female. Overall, 11 (2.6%) subjects experienced complications associated with the anterior iliac crest donor site. The most prevalent anterior iliac crest donor site complications included transient gait disturbance 0.7% (n = 3), hypertrophic scar 0.7% (n = 3), and transient hypoesthesia 0.5% (n = 2). One subject experienced prolonged length of stay, and none required readmission. There were no study variables associated with donor site morbidity.

Conclusion: The overall morbidity associated with anterior ICBG for alveolar cleft repair remains low, with a complication rate of 2.6% (n = 11) associated with the donor site. These results offer strong evidence of the overall safety and minor morbidity of the ICBG harvest for alveolar cleft repair.