CASE: A 50-year-old man underwent reconstruction of 4 left and 3 right rib nonunions using approximately 30 cc of left iliac crest bone graft (ICBG). At 6 weeks, left flank discomfort and swelling developed. CT scan at 8 months revealed hernia at ICBG harvest site. The patient underwent robotic hernia repair 14 months postoperatively. At 20 months, he had returned to work, no recurrence of symptoms, and pain resolution.
CONCLUSION: Major complication of iliac crest bone harvest, abdominal hernia, may result by supra-iliac repair attrition or insufficient abdominal wall reattachment to the bony crest, underscoring importance of surgical site closure.