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Superior Gluteal Artery Injury Secondary to Posterior Iliac Crest Bone Graft Harvesting: A Surgical Technique to Control Hemorrhage

Shin, Alexander Y., MD*; Moran, Mark E., MD; Wenger, Dennis R., MD

Technique
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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

From the *Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California, and the Department of Orthopaedic Surgery, Children's Hospital, University of California, San Diego, San Diego, California.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Defense or of the United States Government.

The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program, sponsored this report #84-16-1968.591, as required by HSETC 6000.41A.

Acknowledgment date: May 22, 1995.

First revision date: July 28, 1995.

Acceptance date: September 15, 1995.

Device status category: 1.

Address reprint requests to: LCDR Alexander Y. Shin, MC, USN; c/o Department of Clinical Investigations; Naval Medical Center San Diego; San Diego, CA 92134-5000

© Lippincott-Raven Publishers.