New Technique Uses Pubic Bone for Grafting

A new technique using the pubic bone as a source of bone for grafting may avoid the complications of harvesting bone from the iliac crest, or 'hip bone,' according to a report in the November/December issue of The Journal of Craniofacial Surgery.

With further study, the pubic bone could become the new standard for harvesting bone grafts for certain types of reconstructive surgery, write Dr. John W. Polley and colleagues of Rush University Medical Center, Chicago.

Dr. Polley and colleagues developed their approach to harvesting pubic bone in a series of cadaver dissections. They found that the pubic bone, found at the front of the pelvis, could be easily reached through a small incision—about 1 inch. Just as importantly, minimal dissection of the soft tissue was necessary to expose the pubic bone and collect the cancellous bone (sponge-like interior bone) needed for grafting.

The researchers report on their initial experience with the pubic bone graft technique in a 10-year-old boy who needed follow-up surgery for a cleft palate defect. The procedure to collect the bone needed for grafting was quick and simple. The day after surgery the patient had little or no pain in the pubic area, which healed without problems.

The iliac crest is the standard site for harvesting bone grafts for reconstructive surgery in the face and jaws, as well as other areas. However, several types of complications can occur after the iliac crest donor procedure, including nerve injuries, pain problems, and scarring.

The pubic bone graft technique is a promising approach to avoiding these problems, Dr. Polley and colleagues point out. Because it requires a small incision with minimal dissection, the pubic bone technique is less traumatic than harvesting bone from the iliac crest site. Since there are no nerves supplying sensation to the skin in the area of the incision, the risk of nerve injury is reduced. Even scarring is less of a concern, because the incision is made in an area normally covered by hair.

"The pubic bone graft compares favorably with more traditional techniques of cancellous bone harvesting," Dr. Polley and colleagues conclude. The procedure appears safe and reliable, allowing faster collection of bone grafts and fewer complications than with the iliac crest technique. With further experience and follow-up, the researchers believe the pubic bone graft could become the new standard for patients undergoing cleft palate reconstruction.

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