Bone graft harvesting: a percutaneous technique

Bone graft donor sites are often a source of significant morbidity. The incidence of donor site complications in one series was 9.4 % and included chronic wound pain and hypersensitivity, buttock anaesthesia, muscle hernia-tion, meralgia paraesthetica (Weikel and Habal 1977) and even subluxation ofthe hip (Cockin 1971). In another series, chronic donor site pain was reported in 25 % of patients and was associated particularly with tricortica! grafts (Summers and Eisenstein 1989). In Sheffield over the past three years we have used a limited percutaneous approach to harvest cancel!ous bone. The technique relies on the use of the Meunier trephine first described for taking bicortical iliac bone biopsies (Jowsey 1977). The needle has four parts (Fig. 1); a flanged trephine with an 8 mm internal diameter, a blunt trocar (above), and an outer sleeve with a sharp introducer (below). The flange on the trephine is used as a handle when cutting the graft and provides a stop to prevent penetration of the soft tissues within the pelvis. Fig. 1 The blunt trocar is used to deliver the graft. A single core will have a volume ranging from 0.6 to 1.2 ml depending on the width of the bone (Fig. 2). As many as five cores may be taken if the incision is extended to 3 cm. Method. A 2 cm incision is made, 5 cm from the anterior superior iliac spine and 2 cm below the iliac crest. The deep fascia is incised and a pair of dissecting scissors is passed perpendicular to the wound and down to the bone.