The harvesting of cranial bone grafts: a guided osteotome.

A technique for in situ harvesting of the outer table of the skull using a "guided" osteotome is presented. While guards have been placed to control the depth of the blade, additional steps are advised to ensure the highest level of safety in clinical use: Before harvesting the graft, a full set of anteroposterior and lateral x-rays should be examined to determine which areas of the skull are thin and should be avoided. All areas with cranial sutures should be avoided because here the dura is more firmly attached to the inner table making perforation more dangerous. Bone should not be harvested under the hairless forehead region because this results in a visible depression. The surgeon should use the guards as guides to visually monitor the depth of the blade. The surgeon should not attempt the procedure without having a set of three different depths (1 mm, 2 mm, and 3 mm) available. Different skulls have different thicknesses of the outer table, and the technique loses the advantage of safety if an inappropriate depth is used.