LAUSR

Iliac crest bone grafts (ICBG) are commonly used to heal non-union fractures in orthopaedic and maxillofacial surgery. The most common complications are pain, haematoma, neurovascular injury and scarring however one complication that is mentioned less frequently is herniation of abdominal contents. We emphasise the importance of this complication, and describe a technique that can be used to repair this when there is herniation. A 76 year old gentleman developed squamous cell carcinoma of the right mandible in 2019. The right mandible was resected, followed by an iliac crest free flap from the left side with a prophylactic prolene mesh which was performed in 2020. The patient then received adjuvant chemotherapy. Shortly thereafter, the patient developed a lump which became increasingly painful. The patient was referred onto the general surgical team after a CT scan showed herniation of colon and small bowel loops at the donor site. The patient underwent a hernia repair in November 2022 and is recovering well. Herniation of abdominal contents following ICBG are rare and potentially dangerous complication that can lead to significant morbidity and even mortality. Here we present an open repair of a recurrent hernia, using a pre-peritoneal mesh. A pre-peritoneal plane was developed all around to ensure there is good overlap of the mesh and was anchored to a mini-plate that was fixed to the iliac bone. Pre-peritoneal meshes should be preferred to fix hernia defects caused from ICBGs, which otherwise can cause significant morbidity in patients with ICBGs.