Pre-Expanded Fronto-Scalp Flaps Combined With Botulinum Toxin and Laser Therapy for Secondary Large-Scale Craniofacial Defects.

BACKGROUND: Secondary facial defects remain a primary focus in plastic surgery, particularly large defects involving the midface, forehead, and scalp. While tissue expansion of the fronto-scalp flap offers a viable reconstructive option, the lengthy expansion period and the issue of post-expansion flap retraction necessitate further solutions. OBJECTIVE: We conducted a prospective, comparative clinical study to investigate the role of Botulinum toxin in the expansion of fronto-scalp flaps. METHOD: Between December 2019 and December 2024, 40 patients with large upper facial or scalp lesions were enrolled and randomly assigned to either the experimental group or the control group. Control group patients underwent tissue expansion combined with postoperative laser hair removal. Experimental group patients received the same tissue expansion and laser therapy, supplemented with Botulinum toxin injections administered both preoperatively (prior to expander implantation) and postoperatively in the forehead and scalp regions. We analyzed and compared parameters including expansion efficiency, post-expansion flap retraction force, postoperative pain scores, and complication rates between the two groups. RESULTS: Baseline characteristics showed no significant differences between the two groups before expander implantation. During the tissue expansion phase, the experimental group demonstrated significantly higher expansion efficiency compared to the control group. At both 3 and 6 months following flap transfer surgery, the post-expansion flap retraction force was significantly lower in the experimental group than in the control group. However, no significant differences were observed in pain scores or complication rates between the two groups. CONCLUSION: Our prospective, comparative study demonstrates that Botulinum toxin application enhances the efficiency of tissue expansion using the fronto-scalp flap for reconstructing large secondary facial and scalp defects. It also reduces post-expansion flap retraction force, ultimately contributing to favorable functional and aesthetic surgical outcomes. TRAIL REGISTRATION: ChiCTR1900027702.