Deep inferior epigastric perforator flap preoperative planning: A comparative analysis between dynamic infrared thermography, computerized tomography angiography, and hand‐held Doppler

Abstract

Introduction: Hand-held Doppler (HHD) sonography and computerized tomography angiography (CTA) are the common assessment tools for deep inferior epigastric perforator (DIEP) flap preoperative planning. CTA is considered the gold standard method for preoperative perforator mapping but necessitates contrast medium and X-ray exposure. Dynamic infrared thermography (DIRT) does not have these drawbacks and allows the detection of hot and cold spots on a given body area. Our study aimed to compare DIRT, HHD, and CTA in perforator mapping for breast reconstruction using DIEP flap.Patients and Methods: From March to September 2020, 12 consecutive patients scheduled for DIEP flap breast reconstruction were preoperatively investigated with HHD, CTA, and DIRT. The patients' mean age was 53 and the mean BMI was 29.23 kg/m 2 . All the reconstructions were due to breast cancer.The results of preoperative perforator mapping on the lower abdomen were compared among the three techniques. All the evidence was compared to the intraoperative findings, during flap harvesting, to establish if the techniques were able to correctly locate the perforator.Results: We detected 178 perforators intraoperatively, 178 with CTA, 178 with DIRT, and 125 with HHD. The latter revealed a lower number of perforator vessels for each patient (10.42 ± 3.58), compared with CTA (14.83 ± 3.04) and DIRT (14.83 ± 4.76). DIRT resulted superior to HHD (p < .05), while no statistically significant difference (p > .05) was found between DIRT and CTA. We calculated a mean sensitivity of 93.87% for CTA, 69.02% for HHD, and 92.06% for DIRT. Conclusion:DIRT is a useful tool in the preoperative planning of DIEP flaps, as it provides information about the location of perforators and the hemodynamic properties of angiosomes. It is easy to use, and it does not involve ionizing radiation. DIRT could represent an innovative and promising implementation of CTA and HHD techniques for preoperative perforator mapping in DIEP breast reconstruction.

Smartphone-based thermography in flap surgery: A systematic review and meta-analysis of perforator identification

“…The meta-analysis, comprising seven studies and 1429 observations, indicates that the overall sensitivity of perforator detection is estimated to be 0.8754 (95% CI: 0.7542; 0.9414). This suggests that the methods employed in the studies were generally effective in identifying perforators and are comparable to other imaging modalities such as CTA and dynamic infrared thermography, as reported in a recent comparative analysis [ 18 ]. Specifically, the sensitivity of CTA was 93.87% whereas handheld Doppler showed lower sensitivity values of 69.02%.…”

An innovative method of reconstructed penis reduction: a case report

“…By checking the intraoperative doppler sound, damage to the main pedicle can be reduced. In particular, it is expected to be more helpful in cases of random flap surgery, where it is difficult to predict the location of the pedicle ( 5 ).…”

Development status of novel spectral imaging techniques and application to traditional Chinese medicine

“…In recent years, the technology has also been applied to the development of new drugs and preoperative preparations for clinical surgery [ 65 , 66 ]. According to one study, the accuracy and reliability of dynamic infrared thermography used in deep inferior epigastric perforator flap breast reconstruction were comparable to those of the well-recognized computed tomography angiography [ 67 ]. Infrared thermal imaging has also been used to analyze skin tissues and identify tissues whose imaging is uneven to diagnose gynoid lipodystrophy [ 68 ].…”