Donor-site Morbidity After Anterior Iliac Crest Harvest for Secondary Alveolar Bone Grafting in Pediatric Cleft Patients: A Narrative Review of Pain and Functional Recovery

Background Anterior iliac crest bone graft remains the standard donor site for secondary alveolar bone grafting (SABG) in cleft lip and palate, but its use is often limited by concerns about donor-site pain, gait disturbance, and long-term morbidity in children. Methods This narrative review synthesized English-language clinical studies on anterior iliac crest harvest for SABG and related pediatric maxillofacial procedures, focusing on pain intensity and duration, gait disturbance and functional recovery, and non-pain complications, as well as the influence of harvest technique and perioperative analgesia. Results Across pediatric cleft and maxillofacial series, donor-site pain and limping peaked in the first postoperative days and improved rapidly over the first weeks, with most children ambulating unaided within days and returning to unrestricted activities within about one month; persistent pain or gait disturbance beyond 3 months was rare. Superficial wound infection, minor hematoma, transient lateral femoral cutaneous nerve symptoms, and mild cosmetic concerns were infrequent, while serious events such as deep infection, fracture, or deformity were exceedingly uncommon. Comparative studies showed that minimally invasive or limited-access harvest techniques, combined with multimodal analgesia and early mobilization, reduced donor-site pain, opioid use, and length of stay without consistently compromising graft adequacy. Conclusion In pediatric SABG, anterior iliac crest harvest carries a largely short-lived and low-grade morbidity profile and remains an appropriate primary donor site when performed with contemporary minimally invasive techniques and structured perioperative care, allowing cleft teams to counsel families with realistic, evidence-based expectations.