Skull and Scalp En-Bloc Harvest Protects Calvarial Perfusion: A Cadaveric Study

Christopher D. Lopez, Alisa O. Girard, Isabel V. Lake, Visakha Suresh, Hossam Abdou, Jonathan J. Morrison, Robin Yang, Chad R. Gordon, Richard J. Redett*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background Calvarial defects are severe injuries that can result from a wide array of etiologies. Reconstructive modalities for these clinical challenges include autologous bone grafting or cranioplasty with biocompatible alloplastic materials. Unfortunately, both approaches are limited by factors such as donor site morbidly, tissue availability, and infection. Calvarial transplantation offers the potential opportunity to address skull defect form and functional needs by replacing like-with-like tissue but remains poorly investigated. Methods Three adult human cadavers underwent circumferential dissection and osteotomy to raise the entire scalp and skull en-bloc. The vascular pedicles of the scalp were assessed for patency and perfused with color dye, iohexol contrast agent for computed tomography (CT) angiography, and indocyanine green for SPY-Portable Handheld Imager assessment of perfusion to the skull. Results Gross changes were appreciated to the scalp with color dye, but not to bone. CT angiography and SPY-Portable Handheld Imager assessment confirmed perfusion from the vessels of the scalp to the skull beyond midline. Conclusion Calvarial transplantation may be a technically viable option for skull defect reconstruction that requires vascularized composite tissues (bone and soft tissue) for optimal outcomes.

Original languageEnglish
Pages (from-to)171-176
Number of pages6
JournalJournal of Reconstructive Microsurgery
Issue number3
StatePublished - 20 Nov 2022
Externally publishedYes


  • perfusion study
  • scalp perfusion
  • skull transplant


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