Precision dissection strategy for myocutaneous flap in frontotemporal cranioplasty based on tissue biophysical properties

Background Safely and efficiently separating myocutaneous flaps that are densely adherent to the dura mater remains a critical challenge in cranioplasty. Traditional dissection methods and prophylactic implantation of anti-adhesion materials both have limitations. This study aims to propose and validate a “Tissue Biophysics-Based Myocutaneous Flap Dissection Strategy.” By systematically analyzing the biophysical properties of different tissue interfaces and dynamically matching the optimal dissection instruments and techniques, we seek to optimize surgical outcomes. Methods We retrospectively analyzed the clinical data of 124 patients who underwent frontotemporal cranioplasty at our institution between January 2020 and September 2025. Patients were divided into a new strategy group ( n = 55) and a conventional group ( n = 69). The new strategy group employed blunt mechanical expansion techniques based on the loose subgaleal plane and low-power selective electrothermal dissection techniques based on the impedance difference between the temporalis muscle and the dura mater. The conventional group received standard dissection methods. We compared operative time, intraoperative blood loss, dural tear rate, postoperative drainage, and complication rates between the two groups. Results The new strategy group demonstrated significantly lower intraoperative blood loss (128.18 ± 45.32 mL vs. 276.81 ± 68.54 mL, P < 0.001), shorter operative time (110.55 ± 18.27 min vs. 162.32 ± 22.65 min, P < 0.001), and a reduced dural tear rate (12.7% vs. 39.1%, P = 0.002) compared to the conventional group. The incidence of postoperative epidural hematoma was also significantly lower in the new strategy group (10.9% vs. 30.4%, P < 0.001). No statistically significant differences were found in the rates of other complications such as infection or epilepsy. Conclusion The proposed “Tissue Biophysics-Based Myocutaneous Flap Dissection Strategy” integrates tissue biophysical principles (e.g., interfacial compliance, electrical impedance differences) into surgical decision-making, aiming to provide a practical surgical strategy. This surgical strategy appears to enhance the safety and efficiency of cranioplasty while reducing the risk of key complications in this patient cohort.