The Value of Dynamic Infrared Thermography in Pedicled Thoracodorsal Artery Perforator Flap Surgery

Abstract

Background: Dynamic infrared thermography (DIRT) is a noninvasive imaging technique that can provide indirect and real-time information on skin perfusion by measuring skin temperature. Although used in flap surgery, there are no reports on its value in procedures using a pedicled thoracodorsal artery perforator (TDAP) flap. The aim of this study was to assess the usefulness of DIRT in preoperative perforator mapping and in monitoring intra- and postoperative flap perfusion of pedicled TDAP flaps. Methods: This prospective study comprised 21 patients (21 flaps) scheduled for reconstructive surgery with a TDAP flap. Perforator mapping was done by DIRT, handheld unidirectional Doppler ultrasound, and computer tomography angiography. Intra- and postoperative flap perfusion was assessed by clinical signs and with the use of DIRT and handheld unidirectional Doppler ultrasound. Results: Perforator mapping with DIRT showed that first-appearing bright hotspots were always associated with arterial Doppler sounds and suitable perforators intraoperatively. Computer tomography angiography presented useful information on the thoracodorsal artery branching pattern but was less beneficial for perforator mapping. Intra- and postoperative flap monitoring with DIRT was more useful than handheld unidirectional Doppler ultrasound and clinical signs to detect early arterial and venous perfusion problems. DIRT demonstrated that TDAP flap perfusion is a dynamic process with an increase in perfusion during the first operative days. Nineteen flaps survived, of which 3 sustained distal necrosis. Two flaps were lost due to inadequate blood perfusion. Conclusion: DIRT provides valuable real-time information for perforator mapping and for monitoring TDAP flap perfusion intra- and postoperatively.

Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

“…25 Currently, dynamic IRT is being used preoperatively in identifying the appropriate perforator vessel to be transplanted as well as in flap monitoring after free flap transplantation, where changes in arterial or venous perfusion influence the skin temperature. 17,23,28 The sensitivities lie between 89.6 and 99.6% and specificities between 96 and 99.9%. 20 After supplying blood to the chest wall, IMA continues to the abdomen wall as the superior epigastric artery, where it anastomosises itself to the inferior epigastric artery to supply the perfusion to the abdominal wall.…”

An animal experiment study on the application of indocyanine green angiography in the harvest of multi-angiosome perforator flap

“…The LDF monitor allows the flap microcirculatory status to be determined intraoperatively, but the results may underestimate the flap viability (22). IRT reflects range of flap perforating blood supply and responds rapidly to changes in blood flow, but is susceptible to external factors, such as room temperature and humidity (23). A spectral analysis indirectly assesses tissue by monitoring tissue conditions, but the operation time is long and the data are susceptible to noise (21).…”

The Use of Infrared Thermography in Determining Timing for Early Pedicle Division of the Preexpanded Bipedicled Visor Flap after Ischemic Preconditioning

“…Repeated ICG angiography is likely to cause greater discomfort to the patient, and the equipment for ICG is cumbersome and quite expensive. On the contrary, IRT possessed a noninvasive detection process and can be applied repeatedly at any time, avoiding traumatic maneuvers and discomfort to the patient [27][28][29]. Furthermore, it can be universally applied with less interference due to skin color.…”