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DOI: 10.1055/s-0039-3402032
Smartphone Thermography for Lower Extremity Local Flap Perforator Mapping
Abstract
Background The versatile application of local perforator flaps for coverage throughout the lower extremity has already been well proven. Often a “free-style” approach has been used to design these flaps, as conventional imaging devices for perforator identification may be too expensive or unavailable. The recent adaptation of Smartphone thermal digital imaging may now prove to be a cheaper and more readily available means for identifying the requisite perforators that will sustain these local flaps.
Methods Over the past year, a prospective study was undertaken of all patients having a local perforator flap for coverage of a lower extremity defect. Twenty-eight local perforator flaps involving all subtypes were utilized in 25 patients. Smartphone thermography was used in all patients preoperatively to identify preferable perforator or vascular network “hot spots” that allowed appropriate flap design. Intraoperative and postoperative monitoring was similarly done for all flaps to determine outcomes.
Results All local perforator flaps were based on perforators identified using smartphone thermography. All flaps (23 or 82.1%) that the thermal digital image predicted 100% viability totally survived. Five flaps were predicted to have marginal viability, but two nevertheless survived completely while the others required only minor readjustments. Peninsular and keystone variety perforator flaps were those most commonly used.
Thermography always facilitated making the correct decision as to whether a proximal- or distal-based peninsular flap would be superior. Subfascial elevation of cool spots in keystone flaps were found to be least likely to interfere with flap perfusion.
Conclusion Smartphone thermography is an inexpensive and expeditious means for identification of “hot spots” that is always used by us to ensure perfusion to lower extremity perforator local flaps. This is a complementary technique for their safer design, harvest, and subsequent monitoring in conjunction with more complex screening tools as indicated.
Keywords
smartphone - thermography - local perforator flap - keystone flap - propeller flap - peninsular flap - island flapNote
This study was presented at the 10th Congress of World Society for Reconstructive Microsurgery, Bologna, Italy, June 14, 2019, and American Society of Plastic Surgery, San Diego, California, September 21, 2019.
Publikationsverlauf
Eingereicht: 11. September 2019
Angenommen: 21. November 2019
Artikel online veröffentlicht:
23. Februar 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 de Weerd L, Mercer JB, Weum S. Dynamic infrared thermography. Clin Plast Surg 2011; 38 (02) 277-292
- 2 de Weerd L, Weum S, Mercer JB. The value of dynamic infrared thermography (DIRT) in perforator selection and planning of free DIEP flaps. Ann Plast Surg 2009; 63 (03) 274-279
- 3 Muntean MV, Strilciuc S, Ardelean F, Georgescu AV. Dynamic infrared mapping of cutaneous perforators. J Xiangya Med 2018; 3: 16
- 4 Pereira N, Valenzuela D, Mangelsdorff G, Kufeke M, Roa R. Detection of perforators for free flap planning using smartphone thermal imaging: a concordance study with computed tomographic angiography in 120 perforators. Plast Reconstr Surg 2018; 141 (03) 787-792
- 5 Koerner S, Adams D, Harper SL, Black JM, Langemo DK. Use of thermal imaging to identify deep-tissue pressure injury on admission reduces clinical and financial burdens of hospital-acquired pressure injuries. Adv Skin Wound Care 2019; 32 (07) 312-320
- 6 Theuvenet WJ, Koeyers GF, Borghouts MH. Thermographic assessment of perforating arteries. A preoperative screening method for fasciocutaneous and musculocutaneous flaps. Scand J Plast Reconstr Surg 1986; 20 (01) 25-29
- 7 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (05) 1529-1544
- 8 Tenorio X, Mahajan AL, Elias B. et al. Locating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge. Ann Plast Surg 2011; 67 (02) 143-146
- 9 Sheena Y, Jennison T, Hardwicke JT, Titley OG. Detection of perforators using thermal imaging. Plast Reconstr Surg 2013; 132 (06) 1603-1610
- 10 Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging. Plast Reconstr Surg 2016; 137 (01) 39-41
- 11 Muntean MV, Achimas-Cadariu PA. Detection of perforators for free flap planning using smartphone thermal imaging: a concordance study with computed tomographic angiography in 120 perforators. Plast Reconstr Surg 2018; 142 (04) 604e
- 12 Pereira N. Reply: detection of perforators for free flap planning using smartphone thermal imaging: a concordance study with computed tomographic angiography in 120 perforators. Plast Reconstr Surg 2018; 142 (04) 605e
- 13 de Weerd L, Mercer JB, Setså LB. Intraoperative dynamic infrared thermography and free-flap surgery. Ann Plast Surg 2006; 57 (03) 279-284
- 14 Itoh Y, Arai K. Use of recovery-enhanced thermography to localize cutaneous perforators. Ann Plast Surg 1995; 34 (05) 507-511
- 15 Chubb D, Rozen WM, Whitaker IS, Ashton MW. Images in plastic surgery: digital thermographic photography (“thermal imaging”) for preoperative perforator mapping. Ann Plast Surg 2011; 66 (04) 324-325
- 16 Muntean MV, Ardelean F, Strilciuc S, Pestean C, Georgescu AV, Muntean V. Flap warming improves intraoperative indocyanine green angiography (ICGA) assessment of perfusion. An experimental study. J Plast Reconstr Aesthet Surg 2019; 72 (07) 1150-1156
- 17 Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64 (03) 386-393
- 18 Hallock GG. The buttock crease adductor magnus peninsular perforator flap as another local flap option for repair of the ischial pressure sore transverse adductor magnus flap. Plast Reconstr Surg 2013; 132 (01) 183e-184e
- 19 Lachica RD. Evidence-based medicine: management of acute lower extremity trauma. Plast Reconstr Surg 2017; 139 (01) 287e-301e
- 20 Koh K, Goh TLH, Song CT. et al. Free versus pedicled perforator flaps for lower extremity reconstruction: a multicenter comparison of institutional practices and outcomes. J Reconstr Microsurg 2018; 34 (08) 572-580
- 21 Hallock GG. A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps. J Reconstr Microsurg 2013; 29 (04) 233-240
- 22 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141
- 23 Cormack GC, Lamberty BGH. The Arterial Anatomy of Skin Flaps. 2nd ed. NY: Churchill Livingstone; 1994
- 24 Riccio CA, Chang J, Henderson JT. et al. Keystone flaps: physiology, types, and clinical applications. Ann Plast Surg 2019; 83 (02) 226-231
- 25 Hallock GG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg 2006; 56 (05) 540-542
- 26 Hallock GG. The medial sural(medial gastrocnemius) perforator local flap. Ann Plast Surg 2004; 53 (05) 501-505
- 27 Hallock GG. The proximal pedicled anterolateral thigh flap for lower limb coverage. Ann Plast Surg 2005; 55 (05) 466-469
- 28 Hallock GG. Doppler sonography and color duplex imaging for planning a perforator flap. Clin Plast Surg 2003; 30 (03) 347-357 , v–vi