• Archives of Plastic Surgery
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• v.38 no.1
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• pp.15-18
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• 2011

Purpose: The anterior iliac crest is a common source for autologous cancellous bone graft. For patients who have previously received cancellous bone grafts from bilateral anterior iliac crests, there may be concerns of whether a sufficient quantity of autologous cancellous bone remains for additional grafts without harvesting it from other sites, such as the posterior iliac crest. Methods: We experienced 3 cases of reharvesting in 2 patients. The diagnosis of the first patient was bilateral facial cleft number 3. This patient received bilateral side cleft alveoloplasty with corticocancellous bone graft from the both anterior iliac crest respectively by a previous surgeon. This patient then needed reharvesting of the anterior iliac crest cancellous bone to correct an ongoing skeletal problem for the bilateral cleft. The other patient had bilateral incomplete cleft of the primary palate. This patient received left side cleft alveoloplasty with cancellous bone graft from the right anterior iliac crest. Before the patient could receive the alveoloplasty on the other side, a radial head osteotomy and cancellous bone graft was performed by orthopedic surgeons who then used the remaining left iliac crest in order to treat a pulled elbow. For the completion of the right side cleft alveoplasty, the anterior iliac crest cancellous bone needed to be reharvested. Prior to the reharvesting, a preoperative computed tomography scan of the pelvis was obtained to assess the maturity of the donor site regeneration. The grafts were then taken from site where a greater amount of regeneration was evident. Results: Long term follow ups showed that the grafts were successfully taken. This sufficient volume was obtainable 14 months after the first harvest. Conclusion: Satisfactory results were achieved after the reharvesting of iliac cancellous bone. Thus, it appears that the reharvesting of the iliac bone is a possible alternative to multiple site grafting, use of allograft or bone substitute materials.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.6
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• pp.586-589
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• 2006

Deep circumflex iliac artery (DCIA) flap can be harvested as a composite free flap and is often used to adequately reconstruct wide mandibular defects. However, the harvesting of this DCIA flap can result in severe osseous defect of the donor site causing a morphologic defect in the iliac crest. To reconstruct this defect of the iliac donor site, several innovative techniques using bioactive ceramic spacers, autogenous rib bone, polylactic acid mesh, or titanium plates have been introduced. Nonetheless, these methods have not been widely used due to high cost, secondary donor site morbidity, difficulty of use, and postoperative dissatisfaction. We used two titanium plates to reconstruct the donor iliac site defect at the harvesting time of primary DCIA flap surgery in the 30-year old female with an ameloblastoma in the left mandible. Postoperatively, both iliac sites were relatively balanced and there were few complications. At the 2 years follow-up, there were no specific abnormal radiographic findings and the patient was very satisfied with her esthetic iliac contouring. In our report, we evaluate the effect of two titanium plates on the reconstruction of the iliac donor site in the aspects of esthetics and usefulness. This technique has many advantages, such as reduced cost, simplicity, decreased postoperative pain or discomfort, and improved bilateral balance of both anterior iliac crest contours, especially in young female patients.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.215-218
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• 2014

Blunt abdominal trauma may often cause multiple vascular injuries. However, common iliac artery injuries without associated bony injury are very rarely seen in trauma patients. In the present case, a 77-year-old male patient who had no medical history was admitted via the emergency room with blunt abdominal trauma caused by a forklift. At admission, the patient was in shock and had abdominal distension. On abdomino-pelvic computed tomography (CT), the patient was seen to have hemoperitoneum, right common iliac artery thrombosis and left common iliac artery rupture. During surgery, an additional injury to inferior vena cava was confirmed, and a primary repair of the inferior vena cava was successfully performed. However, the bleeding from the left common iliac artery could not be controlled, even with multiple sutures, so the left common iliac artery was ligated. Through an inguinal skin incision, the right common iliac artery thrombosis was removed with a Forgaty catheter and a femoral-to-femoral bypass graft was successfully performed. After the post-operative 13th day, on a follow-up CT angiography, the femoral-to-femoral bypass graft was seen to have good patency, but a right common iliac artery dissection was diagnosed. Thus, a right common iliac artery stent was inserted. Finally, the patient was discharged without complications.

• Anatomy and Cell Biology
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• v.51 no.4
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• pp.309-311
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• 2018

In this report, four unusual communications between external and internal iliac veins of the left side have been presented. The lowest communication was the narrowest measuring about 2 mm in diameter, the second measured 6 mm, the third had a diameter of 7 mm and the last communication measured 5 mm in breadth. The upper three communications were twisted in a helical manner. The internal iliac vein had its normal tributaries except that the iliolumbar vein drained into the external iliac vein at the level of the third communication. The external iliac vein was slightly dilated just below the level of lowest communication.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.588-592
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• 2018

Harvesting grafts from the anterior iliac bone has been associated with various complications. A 50-year-old woman presented to our department with a chief complaint of right inguinal swelling and pain. Autologous bone grafts had been harvested on two previous occasions from the right anterior iliac crest for use in the reconstruction of multiple facial fractures. Computed tomography and magnetic resonance imaging revealed a full-thickness bone defect in the right anterior iliac crest. A mass was noted in the right gluteus minimus, while a multilocular cystic mass extended from the right iliac crest defect to the right inguinal region. Both the inguinal mass and gluteal mass were removed under general anesthesia. Following histopathological analysis, the gluteal mass was diagnosed as a venous malformation (VM). Based on the patient's clinical course, iliac bone graft harvesting and trauma to the gluteal region triggered hemorrhaging from the VM. Blood components leaked out from the fragile portion of the iliac bone defect, forming a cystic lesion that developed into the inguinal mass. In this case, a coincidental VM resulted in a rare complication of iliac bone graft harvesting. These sequelae could have been avoided by planning for more appropriate ways to collect the grafts.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.210-217
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• 2020

Objective : To analyze the accuracy of iliac screws using freehand technique performed by the same surgeon. We also analyzed how the breach of iliac screws was related to the clinical symptoms resulting in revision surgery. Methods : From January 2009 to November 2015, 100 patients (193 iliac screws) were analyzed using postoperative computed tomography scans. The breaches were classified based on the superior, inferior, lateral, and medial iliac wall violation by the screw. According to the length of screw extrusion, the classification grades were as follows : grade 1, screw extrusion <1 cm; grade II, 1 cm ≤ screw extrusion <2 cm; grade III, 2 cm ≤ screw extrusion <3 cm; and grade IV, 3 cm ≤ screw extrusion. We also reviewed the revision surgery associated with iliac screw misplacement. Results : Of the 193 inserted screws, 169 were correctly located and 24 were misplaced screws. There were eight grade I, six grade II, six grade III, and four grade IV screw breaches, and 11, 8, 2, and 3 screws violated the medial, lateral, superior, and inferior walls, respectively. Four revision surgeries were performed for the grade III or IV iliac screw breaches in the lateral or inferior direction with respect to its related symptoms. Conclusion : In iliac screw placement, 12.4% breaches developed. Although most breaches were not problematic, symptomatic violations (2.1%) could result in revision surgery. Notably, the surgeon should keep in mind that lateral or inferior wall breaches longer than 2 cm can be risky and should be avoided.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.5 no.2
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• pp.73-84
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• 2007

This study aims to examine changes from differences in the lumbar scoliosis angle and iliac crest height due to abnormal and habitual posture shown in unilateral weight load at standing posture and suggest data for preventing and treating lumbago. The subjects of this study are 16 lumbago patients between twenties and forties with chronic lumbago over six months, but without neurological symptoms. As a result of photographing front and back with three conditions such as weight load on both sides and left or right unilateral weight load posture in order to examine changes of lumbar scoliosis and iliac crest according to changes of posture at unilateral weight load, while scoliosis angle and iliac crest height by habitual unilateral support were increased, those by opposite support were decreased. In conclusion, it was found that habitual unilateral weight load may cause continuous distortion of spinal angle and change of iliac crest height and these may be a factor of lumbago. Therefore, if habitual unilateral weight load state is kept continuously, distortion of lumbar angle and iliac crest height may be greater and common efforts to change habitual unilateral weight load are needed.

• The Journal of the Korean dental association
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• v.49 no.9
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• pp.520-526
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• 2011

Vascularized iliac crest flap include bone tissue of good quality and quantity for mandible segmental defect. Even if fibular flap can contain longer bone tissue, iliac crest has esthetic shape for mandible body reconstruction and large height for implant. Conventional vascularized iliac crest osteomyocutaneous flap is too bulky for reconstruction of intraoral soft tissue defect. But modified flap can reduce soft tissue volume, so is good for functional reconstruction of oral mucosa. It takes only one month for completely replace oral mucosa. The final mucosal texture is much better than other skin paddle flap, especially for implant prosthesis. Donor site morbidity of this method looks same level or less with other modalities functionally and socially. In case of oral mucosa-mandible combined defect, vascularized iliac crest with internal oblique muscle flap shows good outcomes for hard and soft tissue.

• Journal of Korean Neurosurgical Society
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• v.51 no.4
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• pp.227-229
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• 2012

Iatrogenic vascular injuries during lumbar disc surgery may occur rarely but they are serious complications, which can be fatal without appropriate management Prompt diagnosis and management of these complications are imperative to prevent a desperate outcome. A 72-year-Old female with proximal left common iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous deployment of a stent graft in an emergency setting. Postprocedural angiogram demonstrated complete exclusion of the iliac artery laceration. The patient became hemodynamically stable. Two weeks later she complained of vascular claudication. Follow-up angiography revealed decreased arterial flow in the opposite common iliac artery. An additional kissing stent was inserted into the right common iliac artery and the symptoms of vascular claudication disappeared. Endovascular stenting offers a safe and effective method for the treatment of an iatrogenic arterial laceration, particularly in a critical condition. But, the contralateral iliac arterial flow should be kept intact in case of proximal iliac artery injury. Otherwise, additional treatments may be needed.

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.347-353
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• 2010

Objective : Iliac screw fixation has been used to prevent premature loosening of sacral fixation and to provide more rigid fixation of the sacropelvic unit. We describe our technique for iliac screw placement and review our experience with this technique. Methods : Thirteen consecutive patients who underwent spinopelvic fixation using iliac screws were enrolled. The indications for spinopelvic fixation included long segment fusions for spinal deformity and post-operative flat-back syndrome, symptomatic pseudoarthrosis of previous lumbosacral fusions, high-grade lumbosacral spondylolisthesis, lumbosacral tumors, and sacral fractures. Radiographic outcomes were assessed using plain radiographs, and computed tomographic scans. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and questionnaire about buttock pain. Results : The median follow-up period was 33 months (range, 13-54 months). Radiographic fusion across the lumbosacral junction was obtained in all 13 patients. The average pre- and post-operative ODI scores were 40.0 and 17.5, respectively. The questionnaire for buttock pain revealed the following : 9 patients (69%) perceived improvement; 3 patients (23%) reported no change; and 1 patient (7.6%) had aggravation of pain. Two patients complained of prominence of the iliac hardware. The complications included one violation of the greater sciatic notch and one deep wound infection. Conclusion : Iliac screw fixation is a safe and valuable technique that provides added structural support to S1 screws in long-segment spinal fusions. Iliac screw fixation is an extensive surgical procedure with potential complications, but high success rates can be achieved when it is performed systematically and in appropriately selected patients.