Split calvarial bone grafting in patients less than 1 year of age: technical note and use in craniofacial surgery for craniosynostosis

The material of choice for filling cranial defects is autologous split calvarial bone. Up to now, the thin calvarial bone and lack of diploic space in very young children has led surgeons to believe that harvesting of split calvarial grafts can generally not be done under the age of 2 years. We describe a simple technique for successful harvesting of split cranial vault bone in infants less than 1 year of age. This procedure involves squeezing the bone to shear the outer from the inner table, followed by the use of thin sharp osteotomes. This technique has been used most often in fronto-orbital advancement operations for coronal and metopic synostosis. In this series of ten such patients, there was no resorption of the split calvarial grafts. Splitting of the cranial vault bone can be performed on infants as young as 9 months with good results.