Dr.George Varghese MS (Ortho)
A good bone graft is an integral part of a successful Rhinoplasty (Cosmetic Surgery of the Nose).The usual donor sites are calvarium, ribs, olecranon and pelvic bones. A common defect for these grafts is shrinkage of the graft in future years.
A corticocancellous graft of sufficient thickness taken from the iliac crest is thought to overcome the problems and hence the procedure is described.
The graft is harvested from the anterior part of the iliac crest. An incision starting about one centimeter lateral to the anterior superior iliac spine and proceeding poterolarteraly along the crest of ilium is used. The crest is exposed and an osteoperiosteal flap of bone is raised with its attachment retained posteriorly. This flap is resutured to its original position at the end of the harvesting procedure and this serves to maintain the contour of the iliac crest.
Having exposed sufficiently both exterior and inside of the crest, the corticocancellous graft of the required length (usually 3.5-4 cm) is harvested using a sharp osteotome or electric saw.
The graft is then split lengthwise for a thickness of approximately 3-4 mm.
The operation wound is closed in the routine way over a readyvac suction drain which can be removed after 24-48hs.
Advantage of iliac crest graft:
1. The procedure is simple
2. The cortico cancellous graft obtained is sufficient strength and enough volume.
3. The iliac crest graft is expected to prevent further shrinkage.
(My heartfelt thanks to my colleague Dr George Varghese MS (Ortho), Rtd Professor of Orthopedics, Medical College, now Consultant Orthopedic Surgeon in Jubilee Hospital, Trivandrum for helping to get iliac crest in Augmentation Rhinoplasty procedures)
