SAFE AND DEPENDABLE HARVESTING OF LARGE OUTER-TABLE CALVARIAL BONE-GRAFTS

A review of a new technique for the harvesting of split (outer-table) calvarial bone grafts is presented. The use of calvarial bone grafts f or facial reconstructive surgery has become more commonplace in recent years. Low donor site morbidity and availability of adequate amounts of membranous bone in close proximity to the facial surgical site make its use particularly desirable. Unfortunately, the occasional complic ations associated with the harvesting of these grafts can be severe, i ncluding dural tears and/or hemorrhage from a dural sinus, as well as late hematomas and meningitis. The technique herein described involves the use of a long malleable blade in a reciprocating saw. The malleab ility of the blade allows it to conform to the shape of the skull whil e elevating split grafts almost as wide as the blade is long. Twenty s eparate grafts were harvested in 18 patients. The largest measured 7X1 0 cm. The grafts were further contoured after harvesting and used in 3 7 sites. No grafts splintered, and no donor site complications were en countered. While care must of course be exercised with any technique, this one is believed to be a safe and dependable method for the harves ting of split calvarial grafts for facial reconstruction.