Membranous bone healing and techniques in calvarial bone grafting

Membranous bone grafts have become an integral part of facial skeletal reconstruction. The convenience of harvesting the graft material from a single operative site was no doubt the reason for its initial utilization. In recent years membranous bone has been shown to be more resistive to resorption and perhaps even provide greater strength per unit volume than does its endochondral counterpart. These facts plus a relatively hidden, nonpainful donor site make membranous bone a desirable graft material. Grafts can be harvested in a variety of forms from dust to vascularized segments, totally dependent on the need. The various techniques of harvesting and methods of utilization are discussed. Rigid fixation has enhanced these techniques, and as the technical aspects improve, so do the results. The use of membranous bone has expanded from the field of congenital craniofacial surgery to the correction of traumatic facial deformities to purely aesthetic surgery. As more experience is gained, the utilization and indications for membranous bone grafting will continue to expand rapidly.