Anterior Approach to the Iliac Crest

  • Anterior Approach to the Iliac Crest is used for harvesting bone graft.

  • Place the patient supine.

  • Landmarks:
    1. Anterior superior iliac spine.
    2. Iliac tubercle.
  • Incision :
    • The length of incision depends on the amount of bone graft that is required.
    • For an extensive bone graft make an 8-cm incision parallel to the iliac crest and centered over the iliac tubercle.

  • The crest offers a truly internervous plane because muscles either take origin from or insert onto the iliac crest, but do not cross it. 
  •  The tensor fasciae latae, gluteus minimus, and gluteus medius are the muscles affected most directly by grafts taken from the anterior portion of the crest, because they originate from the outer portion of the ilium and are supplied by the superior gluteal nerve.
  • The abdominal muscles take their origin directly from the iliac crest and are supplied segmentally.

  • Retract the skin and identify the iliac crest. Cut down onto the iliac crest with a scalpel.

  • The muscles may be stripped off either the inner or the outer wall of the ilium.
  • Initially, cut down onto the bone using a scalpel.
  • Follow the contour of the bone, sticking to it rigidly
  • After coming around the corner of the crest onto the ilium, continue the dissection using blunt instruments such as a Cobb elevator.
  • The muscles will come away from the bone easily.
  • Alternatively, push a swab into the plane between the iliac wing and the overlying muscles.
  • Using a blunt instrument, introduce more and more of the swab into the plane.
  • The swab will act as a tissue expander, pushing the muscle away from the bone, while at the same time protecting the soft tissues.

  • The Anterior Approach to the Iliac Crest  is not classically extensile. The approach has been described in this section merely as a means of obtaining bone graft.

The structures at risk during Anterior Approach to the Iliac Crest includes:

  1. Both the crest of the ilium and the anterior superior iliac spine should be left intact to preserve the normal appearance of the pelvis.
  2. If the anterior superior iliac spine is taken as graft material, the inguinal ligament might retract, causing an inguinal hernia.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Anterior Approach to the Iliac Crest Anterior Approach to the Iliac Crest Anterior Approach to the Iliac Crest
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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