Uses of Smartphone Thermal Imaging in Perforator Flaps as a Versatile Intraoperative Tool: The Microsurgeon's Third Eye

Yassin, Ahmed M.; Kanapathy, Muholan; Khater, Amr M.E.; El-Sabbagh, Ahmed Hassan; Shouman, Omar; Nikkhah, Dariush; Mosahebi, Afshin

doi:10.1016/j.jpra.2023.08.004

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…The use of smartphone-based thermal imaging for preoperative perforator mapping in perforator-based flaps is a relatively new and promising approach, aiming to overcome the limitations associated with traditional techniques such as Doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography [ 16 , 17 ]. These traditional techniques require highly specialized skills and experience, access to non-portable equipment, the administration of intravenous contrast agents, and often significant financial resources.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas smartphone thermal imaging leverages the heat generated by perforator vessels, making it detectable through infrared thermography. This technology has the potential to provide a cost-effective, easily accessible, and non-invasive means of preoperative planning, intraoperative guidance, and post-operative assessment of flap perfusion [ 17 ]. The limitation of using this device is the use of an ice pack and patient discomfort related to it.…”

Section: Discussionmentioning

confidence: 99%

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Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

Ismail,

Zulfiqar,

Sami

et al. 2024

Cureus

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Objective: To determine the diagnostic accuracy of smartphone thermal imaging for preoperative perforator mapping in perforator-based flaps, taking visual inspection as gold standard. Methodology: It was a cross-validation study conducted at the Department of Plastic Surgery, Dr. Ruth K. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. All adult patients aged 18 to 40 years of either gender undergoing perforator flap surgery were included. Each patient followed the same treatment regimen, which involved the preoperative identification of the perforator location using the FLIR One camera. Subsequently, confirmation was achieved during the surgical procedure through visual inspection. A two-by two table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Results: The mean age of the patients was 30.10±6.87 years, ranging from 18 to 40 years. Most of the patients were males (58.7%), and 41.3% were females. Almost 80.4% were pedicle flaps, and 19.6% were free flaps. The accuracy of thermal imaging was found to be 83.2%, with a sensitivity of 84.3%, a specificity of 80%, a PPV of 92.9%, and a NPV of 62.2%, respectively. Conclusion: Smartphone-based thermal imaging is useful for the diagnosis of perforators and has high sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

Ismail,

Zulfiqar,

Sami

et al. 2024

Cureus

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“…The disadvantage of these Perforator‐flaps is, that they are sensitive to traction and pressure [18]. Perforator‐flaps can be pedicled or used as free‐flap designs with micro‐anastomoses and are usually used for the reconstruction of large tissue defects [27].…”

Section: Surgical Anatomy and Physiology Of The Skinmentioning

confidence: 99%

“…A study by Rabbani et al on 84 pedicled and distant flaps showed a 96 per cent accuracy of TI with a sensitivity of 98.7 per cent and specificity of 75 per cent in detecting vascular insults of the flap [49]. DIRT was further described in intraoperative Monitoring in which the skin surface is exposed to a cold challenge and then the pattern of skin rewarming is analyzed [27].…”

Section: Non‐invasive Flap‐assessment Techniquesmentioning

confidence: 99%

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

Fiedler,

Daaloul

2024

Journal of Biophotonics

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This article provides a comprehensive analysis of modern techniques used in the assessment of cutaneous flaps in reconstructive surgery. It emphasizes the importance of preoperative planning and intra‐ and perioperative assessment of flap perfusion to ensure successful outcomes. Despite technological advancements, direct clinical assessment remains the gold standard. We categorized assessment techniques into non‐invasive and invasive modalities, discussing their strengths and weaknesses. Non‐invasive methods, such as acoustic Doppler sonography, near‐infrared spectroscopy, hyperspectral imaging thermal imaging, and remote‐photoplethysmography, offer accessibility and safety but may sacrifice specificity. Invasive techniques, including contrast‐enhanced ultrasound, computed tomography angiography, near‐infrared fluorescence angiography with indocyanine green, and implantable Doppler probe, provide high accuracy but introduce additional risks. We emphasize the need for a tailored decision‐making process based on specific clinical scenarios, patient characteristics, procedural requirements, and surgeon expertise. It also discusses potential future advancements in flap assessment, including the integration of artificial intelligence and emerging technologies.

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Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction

Fiedler,

Tobias,

Burkard

et al. 2024

Eur Arch Otorhinolaryngol

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Uses of Smartphone Thermal Imaging in Perforator Flaps as a Versatile Intraoperative Tool: The Microsurgeon's Third Eye

Cited by 6 publications

References 32 publications

Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps

An overview of current assessment techniques for evaluating cutaneous perfusion in reconstructive surgery

Smartphone-based thermal imaging for pedicled skin flaps: a pilot study toward objective perfusion assessment in facial, head, and neck reconstruction

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