MIDLINE FASCIAL SPLITTING APPROACH TO THE ILIAC CREST FOR BONE-GRAFT - A NEW APPROACH

The midline fascial splitting approach is a modified midline approach to the iliac crest for bone graft that takes advantage of the anatomic planes between layers of the dorsal lumbar fascia. Two hundred consec utive grafts were taken by this technique with one superficial infecti on, two cases of serous hematoma, and three patients with significant postoperative pain at the harvest site, for an overall complication ra te of 3%. In comparison, bone grafts were harvested from 200 consecuti ve patients by the midline subcutaneous approach to the iliac crest wi th 2 deep infections, 1 cluneal nerve injury, 15 patients with severe and disabling pain at the harvest site, and 12 patients with a serous hematoma, for an overall complication rate of 15%. The midline fascial splitting approach significantly reduced the incidence of postoperati ve serous hematoma (P < 0.007) as well as the incidence of significant and disabling pain (P < 0.001). In addition, the approach is simple, straightforward, anatomic, and decreases trauma to soft tissues.