The percutaneous trephine technique for harvesting iliac crest bone graft in alveolar clefts and its effect on donor site morbidity and quality of bone graft

Abstract 

The percutaneous trephine technique uses a bone marrow biopsy needle to harvest cancellous bone graft from the anterior iliac crest. The subjects of this study were 41 patients with 47 alveolar clefts who underwent secondary bone grafting over a period of 5 years, using the above technique. The donor site morbidity was evaluated retrospectively by means of a postal questionnaire and case note survey. Patients were questioned about severity of pain, duration of pain and duration of limping. None of the patients had donor site pain or limping for more than 2 weeks. No patient had severe donor site pain. Case note surveys revealed no donor site complications of haematoma, sensory disturbance, wound breakdown or contour abnormality. In 85.10% (n=40) of the alveolar clefts where the canine tooth had reached its final position at the bone grafted site, dental radiographs were used to assess the interalveolar septal height. In 82.5% (n=33) the interalveolar septal height was more than three quarters of normal i.e. a successful result. In conclusion the percutaneous technique causes minimal donor site pain and gait disturbance. It is a simple and safe technique, easy to learn and quick to perform leaving the patient with an imperceptible donor site scar. The results of clinical and radiological assessment of the quality of the bone graft also compare favourably with the conventional open technique of harvesting iliac crest graft in cases of alveolar clefts.