Types of Bone Graft Harvesters
There are several types of instruments used for Bone Graft Harvester from the patient's own body (autografts). Some common types include:
Trephine Bone Biopsy Needles: These cylindrical biopsy needles are used to harvest cancellous bone fragments from the iliac crest or other bones. Usually 4-8mm in diameter, they are inserted into the bone and rotated to extract a core sample.
Plexi Cut Bone Biopsy Needles: Similar to trephine needles but with a serrated cutting edge to better grip and extract the bone sample. They come in sizes from 4-10mm.
Bone Scrapers: Oval or curved handheld scrapers are used to scrape or scrape off bone fragments, particles and marrow from the iliac crest or other flat bones. They come in a variety of sizes.
Bone Impactors: These devices allow harvesting blocks or wedges of cortical bone by applying an impact force. ATrephine is first used to create an opening, then the impactor piston drives an osteotome into the opening to Harvest a wedge of bone.
Powered Systems: Some systems utilize powered rotational or oscillating motion to efficiently harvest larger quantities of bone particles and chips. They attach to standard trephine needles or scrapers.
Preparing the Donor Site
For harvesting from the iliac crest, the patient is placed in either lateral or supine position. The skin over the iliac crest is prepped, draped and anesthetized. A linear incision of 2-4cm is made through the skin and fascia. Bleeding from the underlying muscle is controlled.
A trephine, plexi cut or powered system is used to extract multiple cylindrical cores or particles of bone. For block graft harvesting, an osteotome is used following trephination to remove a wedge of bone. Bleeding bone surfaces are cauterized if needed.
The donor site is inspected for any bone fragments left behind and to ensure hemostasis before closure. The fascia, subcutaneous tissue and skin layers are closed with absorbable sutures. A sterile dressing is applied.
Bone Graft Processing
The harvested autologous bone can be processed in several ways before use:
Cancellous Bone Chips: Trephine cores or scraped particles are simply crushed into small cancellous chips using bone nippers or a bone grinder. They maintain osteoinductive properties.
Demineralized Bone Matrix: Bone is processed using an acid extraction to remove minerals, leaving behind osteoinductive DBM. It is flexible and easy to use but less durable than mineralized bone.
Mineralized Bone Chips: Larger cancellous or cortical fragments are cut into small chips that still contain minerals. They are osteoinductive and conductive but less malleable than demineralized bone.
Bone Marrow Aspirate: Marrow is extracted from the iliac crest or other bones using aspiration to obtain mesenchymal stem cells, growth factors and ancellular components for use in orthobiologic applications.
Bone Grafting Techniques and Applications
The autogenous bone harvested can be used in a variety of orthopedic procedures such as:
Spinal Fusion: Placed between transverse processes or in interbody spaces to fuse vertebral segments. Often mixed with graft extenders.
Non-Union Fractures: Used to help fill defects and stimulate healing at fracture sites that have failed to unite.
Socket Grafting: Placed into extraction sites/cavities following tooth removal to preserve bone volume for placement of implants.
Sinus Lifts: Elevated into maxillary sinus floor and walls to increase bone height for dental implants.
Oral/Maxillofacial Surgery: Used in reconstructions following resections, trauma, infections or abnormalities.
arthroplasties: Some procedures pack graft into acetabular or femoral components for ingrowth and fixation.
While autografts have osteoinductive properties, their quantity and quality can be limited by the patient's health and size of the donor site. Allografts and orthobiologics are increasingly used as alternatives or extenders mixed with small amounts of autograft bone. Overall, autogenous bone harvesting provides a versatile grafting material for numerous orthopedic and dental applications when bone defects need reconstruction or augmentation.
Complications of Bone Graft Harvesting
In general, bone graft harvesting has a low morbidity rate when performed appropriately. Some potential complications include:
- Bleeding/hematoma formation at donor site requiring evacuation.
- Infection of incision or underlying bone. Antibiotics are often prescribed.
- Fracture or instability of donor bone (iliac crest) if too much is removed.
- Nerve injury from incorrect placement of incisions or instruments near major nerve trunks like femoral nerve.
- Unsatisfactory bone sample due to sclerotic or pathological bone at donor site.
- Prolonged pain at donor site. Use of corticosteroids and narcotics may be needed.
- Graft failure to heal recipient site due to improper graft/host interface, infection, poor vascularity or biomechanics.
-cosmetic deformity/gait disturbance from large iliac crestectomy.
Most adverse effects are managed non-operatively or with debridement. Alternate donor sites may be needed.
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