SUPERIOR GLUTEAL ARTERY INJURY SECONDARY TO POSTERIOR ILIAC CREST BONE-GRAFT HARVESTING - A SURGICAL TECHNIQUE TO CONTROL HEMORRHAGE

Study Design. This case series and cadaveric dissection illustrates a method of obtaining hemostasis of iatrogenic superior gluteal vessel i njury sustained during posterior iliac crest bone graft harvesting. Ob jectives. To show a simple and effective method of obtaining hemostasi s of the iatrogenic superior gluteal vessel injury associated with pos terior iliac crest bone graft harvesting. Summary of Background Data. Management of superior gluteal vessel injury has included direct press ure, enlargement of the sciatic notch to allow for exposure of bleedin g vessels, retroperitoneal or transperitoneal approaches, and angiogra phic embolization to obtain hemostasis. The authors present several ca ses and a cadaveric study to show a simple and effective technique use d to control hemorrhage secondary to iatrogenic superior gluteal vesse l injury sustained at the time of posterior iliac crest bone graft har vesting. Methods. The management of iatrogenic superior gluteal vessel injury secondary to posterior iliac crest bone graft harvesting invol ved the extension of the surgical incision, detachment of the origin o f the gluteus maximus, lateral retraction of the gluteus maximus along with the tethered superior gluteal vessels, and visualization and lig ation of the injured vessels. Results. Hemostasis was achieved quickly with minimal loss of blood. Additional surgery or angiographic emboli zation was not required. Conclusions. In the cases presented, extensio n of the posterior iliac bone graft incision, detachment of the origin , and reflection of the gluteus maximus provided excellent exposure an d hemostasis of the iatrogenic laceration of the superior gluteal arte ry. This technique is simple and effective and may prevent the need fo r transperitoneal and retroperitoneal approaches or angiographic embol ization.