Iliac Crest Harvest

Chapter 13. Iliac Crest Harvest

Indications: The iliac crest provides adequate bone in patients who require a bone graft. The iliac crest is a bone donor site that can be used as an alternative to the cranium or the rib. It too has an inner cancellous marrow bounded on either side by cortical bone. Either the outer or inner tables of cortex can be harvested for grafting.

Neuroanatomy: Care must be taken to avoid the lateral femoral cutaneous nerve, which innervates the skin of the lateral thigh. It exits the abdomen medial to the anterior superior iliac spine, deep to the inguinal ligament and in a groove between the sartorius and iliacus muscles. Injury to the nerve, called “Bernhardt syndrome,” should be avoided at the time of iliac crest harvest. The ilioinguinal nerve runs between the external abdominal oblique and the internal abdominal oblique muscles at the level of the pelvic brim. It provides sensation to the root of the penis, scrotum, and anteromedial aspect of the thigh. It can be injured during harvest of the inner cortex of the iliac crest. Injury to the superior cluneal nerves has been reported at the time of posterior iliac crest bone harvest. The cutaneous superior cluneal nerves cross beneath the inguinal ligament in the lateral portion of the groin closer to the anterior superior iliac spine. As such, the incision is planned just lateral to the spine.