Abdominal Fistula: A Rare Postoperative Complication of Anterior Iliac Crest Graft Harvest in Bimaxillary Reconstruction.

Autogenous bone grafts are considered the gold standard for reconstructing maxillofacial bony defects due to their osteogenic, osteoconductive, and osteoinductive properties. The anterior and posterior iliac crests are commonly used donor sites, providing sufficient quantities of bone for various clinical settings. However, iliac crest bone harvesting can lead to considerable postoperative complications such as wound infection, hematoma, pain, and gait disturbance. This report details a rare postoperative complication encountered by the Oral and Maxillofacial Surgery (OMFS) team at King Fahad University Hospital (KFUH): the formation of an abdominal fistula following anterior iliac crest bone harvesting for bimaxillary reconstruction. A 51-year-old female patient presented with a three-month history of an open abdominal wound with clear liquid discharge at the site of a previous left anterior iliac crest graft. Clinical and radiographic investigations, including a contrasted abdominal and pelvic CT scan, confirmed a deep abdominal cutaneous fistula extending into the left iliacus muscle. Fistulectomy was performed, and the patient showed satisfactory healing over a six-month follow-up period without recurrence. This case highlights the importance of thorough preoperative evaluation, awareness of potential complications, and consideration of alternative donor sites in the presence of previous scarring to minimize postoperative morbidity.