What is a Bone Graft Harvester?

A bone graft harvester is a surgical instrument used by orthopedic surgeons to efficiently collect bone fragments from the pelvis or other bones during a bone graft procedure. Bone grafts are commonly used to help heal fractures that are difficult to mend on their own or promote fusion in spinal surgeries. Traditionally, bone graft collection involved using surgical burs or osteotomes to manually scrape and collect small fragments of bone. However, bone graft harvesters aim to make this process faster, less strenuous for surgeons and maximize the amount of viable bone collected.



How does a Bone Graft Harvester work?

Most Bone Graft Harvester work using a hollow cylindrical or spherical scraping head attached to a long shaft that is manipulated by the surgeon. The scraping head is placed against the bone and rotated manually or using a powered motor. As it rotates, sharp edges or teeth on the scraping head gently scrape off bone slivers and fragments and collect them inside the hollow chamber. Some advanced harvesters come with irrigation channels to wash bone debris into the collection chamber with saline. Once an adequate amount of bone is harvested, surgeons simply remove the full chamber from the patient. This allows for a much larger volume of autologous graft to be collected compared to traditional scraping techniques.



Advantages of using a Bone Graft Harvester

The main advantage of using a bone graft harvester is improved efficiency and speed of bone collection. Studies have shown harvesters can collect up to 10 times more bone volume in much less time compared to manual scraping. This translates to reduced operating times and Stress on orthopedic surgeons. Another key benefit is harvesters cause less damage to surrounding soft tissues compared to osteotomes as they only gently scrape bone. This minimizes bleeding and post-surgical pain for patients. The hollow collection chamber ensures no bone slivers are left behind in the harvest site. This maximizes the amount of viable graft that can be used for fusion which improves clinical outcomes. Some advanced harvesting systems also include features like irrigation to reduce heat necrosis of the bone fragments collected.



Types of Bone Graft Harvesters

There are two main types of bone graft harvesters available to orthopedic surgeons:



1. Hollow Cylindrical scrape harvesters: These are the most common type and utilize a hollow cylindrical cutting head attached to a long shaft. The cylindrical head is placed over the bone and rotated manually or using a power drill to scrape off bone. Bone debris is collected inside the chamber. Advantage is simple design leads to low cost. Disadvantage is can clog if too much bone is taken at once.



2. Spherical harvesting systems: These more advanced harvesters use a spherical rotating cutting head instead of a cylinder. The spherical head is designed to scrape all angles of the bone more efficiently collecting more material in less time. they often include irrigation and suction channels to reduce clogging. However can be more costly than cylindrical designs.



Where are Bone Grafts Harvested From?

The most common sites orthopedic surgeons harvest bone grafts from include:



- Iliac Crest (hip bone): Harvested from the outer edge of the iliac crest in the pelvis. Considered the gold standard as it provides structural cancellous (spongy) bone ideal for fusion. However harvesting from the iliac crest is associated with donor site pain.



- Tibia (shin bone): Cancellous bone can be collected from the upper end of the tibia. Provides similar graft quality to iliac crest with less morbidity. Disadvantage is smaller volume can be taken.



- Distal Femur: Cancellous bone from around the knee jointline of the femur. Provides less structural strength than iliac crest but reduces risk of fracturing the femur.



- Ribs: Trabecular bone can be harvested when ribs are removed during other chest or thoracic procedures. Provides a large cancellous graft but with less structural properties compared to iliac crest or tibia.



Clinical Applications of Bone Graft Harvesters

Bone graft harvesting using a bone graft harvester is commonly used in the following orthopedic procedures:



- Spinal fusion surgery: Bone graft is essential to fuse vertebrae during procedures like lumbar fusion for low back pain or cervical fusion for neck issues.



- Joint reconstruction: Harvested bone is used to fill voids and promote healing during knee, hip or shoulder replacement or reconstruction surgeries.



- Trauma/non-union fractures: When fractures are slow to heal or fail to unite properly, bone grafting can augment the healing process and fill gaps.



- Tumor resection: Defects left after bone tumor removal procedures require filling with graft to encourage bone regrowth.



- Dental/maxillofacial reconstruction: Dental extractions, cleft palate repair or reconstruction of facial bones after traumatic injuries often use bone grafts harvested with these tools.



In the bone graft harvesters have become an invaluable tool for orthopedic surgeons performing bone grafting procedures. Their ability to quickly and efficiently collect high volumes of graft material helps improve surgical efficiency and patient outcomes. As harvesting techniques continue to advance, more spinal and orthopedic cases will benefit from use of these instruments.

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