Complications associated with the harvesting of cranial bone grafts

This study was undertaken to determine the incidence of serious neurologic injury associated with the harvesting of cranial bone grafts. A personal series of 1000 consecutive bone-grant harvestings (cranial, iliac, costal, tibial, and mandibular) was examined in detail for complications. Then a survey of members of the International Society of Craniofacial Surgeons was performed, and data were compiled on complications of bone-graft harvestings performed by the respondents. Data also were compiled on neurologic complications related to cranial bone-graft harvestings performed by other surgeons which the respondents were aware of through direct personal knowledge, medicolegal review, the medical literature, or other channels. No neurologic complications were associated with any of the 586 cranial bone grafts taken in the authors' series. The survey respondents reported that they had performed 12,672 cranial bone-graft harvestings. Temporary neurologic complications were associated with graft harvesting in 3 cases (0.02 percent). The respondents also identified 8 other neurologic complications (4 permanent and 4 temporary) associated with cranial bone-graft harvestings performed by other surgeons. Five cases were performed by surgeons having little or no experience in harvesting cranial bone grafts, and three were performed by surgeons having only limited training. It appears that cranial bone grafts can be harvested with an extremely low incidence of serious complications by surgeons who have had proper training. Techniques are suggested for safe harvesting of cranial bone grafts, as well as for detecting and managing complications when they arise.