A Y Shin1, M E Moran, D R Wenger. 1. Department of Orthopaedic Surgery, Naval Medical Center San Diego, California, USA.
Abstract
STUDY DESIGN: This case series and cadaveric dissection illustrates a method of obtaining hemostasis of iatrogenic superior gluteal vessel injury sustained during posterior iliac crest bone graft harvesting. OBJECTIVES: To show a simple and effective method of obtaining hemostasis of the iatrogenic superior gluteal vessel injury associated with posterior iliac crest bone graft harvesting. SUMMARY OF BACKGROUND DATA: Management of superior gluteal vessel injury has included direct pressure, enlargement of the sciatic notch to allow for exposure of bleeding vessels, retroperitoneal or transperitoneal approaches, and angiographic embolization to obtain hemostasis. The authors present several cases and a cadaveric study to show a simple and effective technique used to control hemorrhage secondary to iatrogenic superior gluteal vessel injury sustained at the time of posterior iliac crest bone graft harvesting. METHODS: The management of iatrogenic superior gluteal vessel injury secondary to posterior iliac crest bone graft harvesting involved the extension of the surgical incision, detachment of the origin of the gluteus maximus, lateral retraction of the gluteus maximus along with the tethered superior gluteal vessels, and visualization and ligation of the injured vessels. RESULTS: Hemostasis was achieved quickly with minimal loss of blood. Additional surgery or angiographic embolization was not required. CONCLUSIONS: In the cases presented, extension of the posterior iliac bone graft incision, detachment of the origin, and reflection of the gluteus maximus provided excellent exposure and hemostasis of the iatrogenic laceration of the superior gluteal artery. This technique is simple and effective and may prevent the need for transperitoneal and retroperitoneal approaches or angiographic embolization.
STUDY DESIGN: This case series and cadaveric dissection illustrates a method of obtaining hemostasis of iatrogenic superior gluteal vessel injury sustained during posterior iliac crest bone graft harvesting. OBJECTIVES: To show a simple and effective method of obtaining hemostasis of the iatrogenic superior gluteal vessel injury associated with posterior iliac crest bone graft harvesting. SUMMARY OF BACKGROUND DATA: Management of superior gluteal vessel injury has included direct pressure, enlargement of the sciatic notch to allow for exposure of bleeding vessels, retroperitoneal or transperitoneal approaches, and angiographic embolization to obtain hemostasis. The authors present several cases and a cadaveric study to show a simple and effective technique used to control hemorrhage secondary to iatrogenic superior gluteal vessel injury sustained at the time of posterior iliac crest bone graft harvesting. METHODS: The management of iatrogenic superior gluteal vessel injury secondary to posterior iliac crest bone graft harvesting involved the extension of the surgical incision, detachment of the origin of the gluteus maximus, lateral retraction of the gluteus maximus along with the tethered superior gluteal vessels, and visualization and ligation of the injured vessels. RESULTS: Hemostasis was achieved quickly with minimal loss of blood. Additional surgery or angiographic embolization was not required. CONCLUSIONS: In the cases presented, extension of the posterior iliac bone graft incision, detachment of the origin, and reflection of the gluteus maximus provided excellent exposure and hemostasis of the iatrogenic laceration of the superior gluteal artery. This technique is simple and effective and may prevent the need for transperitoneal and retroperitoneal approaches or angiographic embolization.