Authors of section

Authors

Scott Bartlett, Michael Ehrenfeld, Gerson Mast, Adrian Sugar

Executive Editor

Edward Ellis III

General Editor

Daniel Buchbinder

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Cleft lip and palate - Harvest of cancellus bone

1. Positioning

Supine.

2. Approach

Incision should be placed in the "bikini line" lateral to the anterior iliac crest.

cleft lip and palate   harvest of cancellus bone

The direction of the approach should then be changed to allow direct access to the iliac crest. Minimal tissue dissection is carried out to avoid opening up tissue spaces.

cleft lip and palate   harvest of cancellus bone

An incision is made lateral to the anterior crest in the avascular plane superior to the upper lateral thigh muscles down to cartilage or bone.

A transverse incision is made across the iliac crest approximately 1 cm behind the anterior superior iliac spine (to avoid damage to the lateral cutaneous nerve of the thigh).

cleft lip and palate   harvest of cancellus bone

3. Exposure of the cancellous bone

Orthopedic osteotomes are then used to perform transverse...

cleft lip and palate   harvest of cancellus bone

...and sagittal osteotomies to raise the crest pedicled medially on the muscles of the abdominal wall and exposing the cancellous bone.

Note: In children with a cartilaginous iliac cap the crest can simply be raised by raising the cartilage from the bone with a knife (without the use of osteotomes).

cleft lip and palate   harvest of cancellus bone

4. Harvest of the cancellus bone

A narrow orthopedic gouge is then used to harvest cancellous bone.

cleft lip and palate   harvest of cancellus bone

When sufficient bone has been obtained the defect in the ilium is packed with a hemostatic agent.

cleft lip and palate   harvest of cancellus bone

5. Wound closure and insertion of epidural cannula

The lid is replaced and fixed with strong resorbable sutures.

cleft lip and palate   harvest of cancellus bone

Pearl: For good postoperative pain control, an epidural cannula may be inserted into the wound and secured to skin with adhesive tape.

cleft lip and palate   harvest of cancellus bone

The wound is then closed in layers with resorbable sutures.

cleft lip and palate   harvest of cancellus bone

Particular attention is paid to the use of a buried subcuticular suture for the final skin closure with the knot on each end also buried.

Ideally, the use of a subcuticular closure with a resorbable suture will obviate the need of suture removal.

cleft lip and palate   harvest of cancellus bone

The wound closure can also be reinforced by adhesive tape and a dressing

cleft lip and palate   harvest of cancellus bone

The wound is then filled with long acting local anaesthetic through the epidural cannula.

cleft lip and palate   harvest of cancellus bone