Nasofacial Reconstruction with Calvarial Bone Grafts in Compromised Defects

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To determine the utility of calvarial bone grafting in multiple reconstructive settings. In particular to examine the success of calvarial bone grafting of the nasofacial skeleton in a compromised wound bed. Case series. A retrospective review was performed to identify patients undergoing calvarial bone graft reconstruction of the nasofacial skeleton. Patients were identified from operative records and the medical record was reviewed to identify age, gender, site of defect, indication for the operation, size of bone graft harvested, postoperative and delayed complications, radiation exposure, need for additional soft tissue, and graft loss. Eighty-seven patients who underwent split calvarial bone grafts were identified and had a complete medical record available for review. Ninety grafts were harvested. Five subsites in the nasofacial skeleton were identified as sites for reconstruction. Forty cases were performed for revision of a previous complication, including 13 who had a previous alloplastic implant. Twenty-four additional cases were performed in a compromised wound bed and 64% of all cases were performed in either a revision or compromised setting. There was an 11% incidence of early postoperative complications, but there were no major complications at the donor site and only two major complications at the recipient site. Calvarial bone is a very useful material in the primary, revision, and compromised settings. This series suggests that split calvarial bone grafts is an adaptable, durable, and reliable material. It can be reliably used in the setting of radiation, infection, and inflammation.