http://www.medilaw.tv Bone Graft Harvesting Surgery anterior iliac crest cancellous chips law presentations. Illustrates the surgical technique for performing the removal of cancellous bone from the anterior iliac crest using an excised cortical window approach. This bone is used elsewhere in the body to assist bony fusion. Also shown is the patient position, skin preparation and incision, the surgical approach, the removal of the cancellous bone, application of a hemostasis pad and finally wound closure.
Bone Graft Harvesting Surgery anterior iliac crest cancellous chips law presentations.
A bone graft is bone placed at the desired fusion site to accelerate the fusion process. The bone can be harvested from somewhere on the client, called an autologous transplant or autograft, from another person, called an allograft, or a natural or synthetic bone substitute can be used. Autografts have higher fusion rates, and no immune rejection or disease transmission risks. Their disadvantages are that the additional procedure to remove the bone graft can increase post-operative pain, has its own complication risks, the bone is limited in its size, shape, quality and amount, especially in children, and it more often requires internal stabilization hardware and bracing for initial support.
BONE MORPHOGENETIC PROTEINS
Bone morphogenetic proteins are a group of naturally occurring proteins that have been shown to attract bone-forming cells, and to stimulate cells to form bone, a process called osteo-induction. They can be made in the laboratory using genetic engineering, when they are called recombinant bone morphogenetic protein.
BMPs can be placed at the fusion site in spine surgery and avoid the need for bone graft.
BMPs are
- expensive when compared to using bone graft, but they
- decrease the time for fusion by one third,
- increase the rate of successful fusion from 70 to 80% up to over 90%,
- avoid the pain, blood loss and risk of infection and nerve damage of bone graft harvesting from the client,
- avoid the risk of infection from using bone graft from another person, and
- lead to a quicker discharge from hospital and more rapid return to normal activities.
INSTRUMENTATION
Metal rods, plates and screws are used to provide immediate rigid internal stabilization at the fusion site while the bone fuses over three to nine months. Then the fused bone will immobilize the fusion site and the instrumentation is no longer required. The instrumentation is usually left in place, as the cost and risks of removal exceed the benefits gained. If the bony fusion does not occur, the instrumentation will eventually break.
Bone Graft Harvesting Surgery anterior iliac crest cancellous chips law presentations.
BONE GRAFT GOAL
The goal of the bone graft harvesting procedure is to obtain a sufficient amount of bone graft for the fusion operation, while minimizing the effects of its removal.
TECHNIQUE
You will be lying on your back and the skin over your hip will be cleaned. An incision will be made over the anterior iliac crest, and a window will be chiseled into the thick outer cortical bone. Inner cancellous bone will then be removed for grafting. A haemostasis pad to stop bleeding will be applied, and then the wound closed with sutures.
POTENTIAL COMPLICATIONS OF BONE GRAFT HARVESTING
BONE GRAFT DONOR SITE DEFECT
Removal of bone graft from a donor site may lead to a defect in the smooth line of the skin, under the surgical scar. This is not usually visible, but can be felt, especially in thin people.
BONE GRAFT DONOR SITE FRACTURE
Removal of bone graft from the iliac crest can stress the adjacent bone, and weaken the region. Although uncommon, this can lead to a fracture through the pelvis some time later. It is more likely in people with pre-existing osteoporosis.
BONE GRAFT DONOR SITE PAIN
Removal of bone graft from a donor site will cause pain at the site, after the procedure. The amount and duration of pain depends on the location and amount of bone removed. The pain usually settles over a few months, but can continue for years. Pain can also be caused by injury during access to the bone, or injury or tension on nearby nerves. Bone Graft Harvesting Surgery anterior iliac crest cancellous chips law presentations.
Loading...
9:44
Microscope: Autologous bone harvesting from iliac crest 3/4by DocMassimoMazza1,500 views
Link to this comment:
All Comments (0)