Clinical outcomes of conservative bone trocar versus conventional open technique in pediatric Iliac crest harvesting for alveolar bone grafting.

Abstract

Purpose: This study aimed to compare the postoperative clinical outcomes between the conservative bone trocar and open conventional techniques for iliac crest bone harvesting for alveolar bone grafting.

Methods: The study included 20 unilateral cleft patients aged between 8 and 11 years, just before canine eruption, who suffered from oro-nasal communication, and were divided into two groups. Group A: ten patients using the open technique with a 4 cm incision at the anterior superior iliac crest for harvesting bone chips. Group B: ten patients using a conservative technique with a 1 cm incision at the anterior superior iliac crest using a special bone trocar extractor and curette. Postoperative evaluation included the Visual Analogue Scale (VAS) for pain assessment to compare the level of pain postoperatively. Also Vancouver scale was used for scar wound evaluation through clinical examination of wound size and concerning tissue vascularity, pigmentation, pliability, and height.

Results: There were no postoperative complications observed, including infection, dehiscence, and graft resorption in both groups. Two weeks postoperative: Group A reported significantly higher pain (7.8 ± 0.79) compared to Group B (3.6 ± 0.97) & p < 0.001, indicating statistically significant lower pain levels in Group B. Regarding the Vancouver Scar Scale, two weeks postoperative: Group A had significantly higher scar severity (9.1 ± 0.88) compared to Group B (3.0 ± 0.82) and p < 0.001, suggesting better scar satisfaction in Group B. One month postoperatively, Group B over time confirmed better scar appearance.

Conclusion: Autogenous iliac crest using a conservative technique with a bone trocar is significantly more beneficial, less painful, and provides better wound scar healing satisfaction than the standard open approach in terms of VAS pain scale and Vancouver scar scale.