| The minimization of morbidity in cranio-maxillofacial osseous reconstruction: Bone graft harvesting and coral-derived granules as a bone graft substitute | ||
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In study II a total of 84 patients had bone harvested using a power driven trephine from a total of 86 anterior iliac crest sites for a total of 333 cores (3.96 cores per patient). Forty-one patients were discharged on the same day as the operation. The volume of bone obtained ranged from 3 ml to 21 ml per harvest site (1–7 cores of 4 mm by 30–38 mm). The bone volume obtained was dependent on the size of the defect to be filled. Intra-operatively, one complication occurred [1 of 333 cores (0.3%)], namely, breakage of an instrument without perforation of the medial or lateral walls of the ilium, or excessive bleeding. There were no reports of paresthesias in the distribution of the lateral femoral cutaneous nerve. The complications rate was 3/84 (3.6%). No complication produced any long-term effects. The complications included the broken instrument mentioned above, 1 case with a gait disturbance of greater than 3 days duration and 1 case with pain related to the cancellous core harvest procedure of greater than 3 days duration. Patients surveyed up to 6 months post-operatively showed positive results, as they were content with the harvesting procedure (Table 7).
Table 7. Post-operative morbidity following trephined cancellous core harvesting procedure. (Results of a telephone interview) in study II.
| Variable Assessed | Incidence |
|---|---|
| Post-operative Gait Disturbance ( > 3 days duration) | 1 / 84 (1.2%) |
| Pain Related to the Trephined Cancellous Core Bone Harvest Procedure ( > 3 days duration) | 1 / 84 (1.2%) |
| Patient Satisfaction with the Trephined Cancellous Core Bone Harvest Procedure | 83 / 84 (98.8%) |
In study III the mean time to unassisted ambulation in patients following a cancellous core harvest was 0.8 days (Table 8). All of these patients ambulated on the first post-operative day. The majority of patients (96%) ambulated unassisted. The mean time to unassisted ambulation in patients following a corticocancellous block graft was significantly longer at 2.8 days (Table 8).
Table 8. Time to unassisted ambulation and length of hospital stay following harvest of corticocancellous block grafts and cancellous cores from the anterior ilium in study III.
| Morbidity Parameter | Group 1 | Group 2 | P |
|---|---|---|---|
| Time to Unassisted Ambulation | 2.8 (2–4) | 0.8 (0–1) | < 0.01 |
| Length of Hospital Stay | 4.1 (3–5) | 2.2 (0–4) | < 0.05 |
| Group 1 (corticocancellous block grafts), n = 22; Group 2 (cancellous cores), n = 54; Means and Ranges in days. | |||
The mean length of hospital stay following a cancellous core graft was 2.2 days. The mean length of hospital stay following a corticocancellous block graft was significantly longer at 4.1 days (Table 8).
The mean contemporaneous maxillofacial pain scores following procurement of cancellous core grafts (day 1: 5.6; day 3: 4.2) and procurement of corticocancellous block grafts (day1: 5.8; day 3: 4.5) were not significantly different. The mean hip pain score was significantly greater (p < 0.05) on day 1 in patients having undergone a corticocancellous block graft (pain score: 6.2) than in patients having undergone a cancellous core graft (pain score: 3.0) (Table 9).
Table 9. Maxillofacial and pelvic pain scores following harvest of corticocancellous block grafts and cancellous cores from the anterior ilium in study III.
| Site | Day | Pain Group 1 | Pain Group 2 | P value |
|---|---|---|---|---|
| Maxillofacial | 1 | 5.8 | 5.6 | NS |
| Maxillofacial | 3 | 4.5 | 4.2 | NS |
| Iliac | 1 | 6.2* | 3.0* | < 0.05 |
| Iliac | 3 | 5.8* | 1.6* | < 0.01 |
| Group 1 (corticocancellous block grafts), n = 22; Group 2 (cancellous cores), n = 54; Means; NS (no significant difference). Asterisk denotes a significant difference between values. | ||||
The mean pelvic pain did not decrease by the third post-operative day in patients having undergone a corticocancellous block graft (pain score: 5.8), but did decrease in patients having undergone a cancellous core graft (pain score: 1.6). The difference in mean pain score between the two graft groups at day 3 was even more highly significant (p < 0.01) than at day 1 (p < 0.05).
All but two of the patients who underwent a cancellous core graft harvest technique were discharged from hospital by the second post-operative day. Post-operative assessment at 1 week identified gait disturbance in 15 of 22 patients (68 %) who underwent a corticocancellous block graft. By contrast, only 1 of the 54 patients (1.9 %) who underwent a cancellous core graft harvest exhibited an abnormal gait No other complications were noted.