Dynamic infrared thermography (DIRT) in Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: standardization of the measurement set-up

Abstract

Breast reconstruction with an autologous free Deep Inferior Epigastric Perforator (DIEP) flap is one of the preferred options following mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap. The current golden standard for perforator mapping is computed tomography angiography (CTA). However, this is a relatively expensive imaging modality that requires intravenous contrast injection and exposes patients to ionizing radiation.More recently, dynamic infrared thermography (DIRT) has been proposed as an alternative imaging modality for perforator identification. DIRT appears to be an ideal alternative technique not only for the identification of the dominant perforators, but also for the mapping of the individual influence of each perforator on the flap perfusion. Multiple studies have been performed with the use of DIRT, unfortunately without standardisation of the measurement set-up. In this technical note we propose a standardised and reproducible measurement set-up for the use of DIRT during breast reconstructions with a free DIEP flap. This set-up can be used pre-, intra-and postoperatively. A standardised measurement set-up will improve the quality of measured data and ensure reproducibility.

Dynamic Infrared Thermography (DIRT) in Biomedical Applications: DIEP Flap Breast Reconstruction and Skin Cancer

“…In breast reconstructions with DIEP flaps, the skin and subcutaneous tissue from the patient's lower abdomen are used as a free flap to reconstruct the breast. One of the key elements in DIEP flap surgery is the selection of the best perforator to obtain sufficient blood supply to the flap after anastomosis [6]. The diagnosis of skin lesions measures the thermal response to thermal stress (cold provocation).…”

Dynamic infrared thermography for DIEP flap breast reconstruction: initial processing results

“…The subjective interpretation of IR images is crucial as the results can generate additional information concerning the hemodynamic properties of the flap. At least the majority of papers which include thermographic assistance in medical application do not mention the use of post-processing techniques to enhance the resulting images [1,2]. The interpretation without post-processing enhancement is often known to be equivocal.…”

Air Flow Cooling Improves Anterolateral Thigh Perforator Mapping Using the FLIR ONE Thermal Camera

“…32,33 The lack of methodical standardization is one of the few downsides of DIRT and the great variety in measurement setups renders the comparison of different techniques difficult. 34 Four cold challenge methods commonly found in literature such as alcoholic disinfection, 35 wet laparotomy sponge or towel, 36 airflow produced by fan, 33,37,38 cold pack, or plastic bags filled with cold water, 34,39,40 were chosen for this study. The use of a cold metal plate was excluded beforehand, as it creates an uneven cooling pattern and does not adjust to the thigh curvature.…”

“…The use of a cold metal plate was excluded beforehand, as it creates an uneven cooling pattern and does not adjust to the thigh curvature. 40 The aim of this study was to investigate both advantages and disadvantages of four frequently used precooling methods for thermographic imaging of ALT perforators to support protocol standardization of recovery-enhanced thermography and to match thermal hot spots with perforators identified by duplex ultrasound.…”