Introduction

Allograft use has been increasing because donor site morbidity is avoided. Although this benefit is well understood, the drawbacks are more complicated and less well understood. The purpose of this chapter is to collect information on potential allograft risk and allograft complications to help surgeons in their risk-benefit analyses. Some of the information contained in this chapter can be found elsewhere in the chapters on stability results (see Chapter 69) and infections (see Chapter 70). Potential allograft complications/risks can be divided into three categories: (1) graft failure or increased laxity and late graft laxity; (2) infection; and (3) disease transmission. The first two also occur with autografts; the third is allograft specific. Potential causes for increased allograft laxity are: (1) radiation sterilization; (2) nonradiation sterilization; (3) freezing; (4) increased donor age; and (5) increased allograft shelf life. Potential causes for increased allograft infection and disease transmission risk are: (1) failure to follow tissue-handling guidelines; (2) fraudulent procurement practices; (3) lack of sterilization; (4) foreign body effects; and (5) harvest/preparation contamination.These are summarized in Box 71-1. It is of interest to note that two of these factors involve human error by individuals not within the surgeon’s control. This highlights the inherently increased risk in allografts versus autografts attendant to the fact that so many delicate and exacting tasks must be properly performed before the graft gets to the operatingroom. Most tissue banks are run meticulously and with great care. However, human error, or intentional human misbehavior, can occur with the surgeon unaware.

Areas of Morbidity