Die Smartphone-basierte Thermographie zur Lokalisation von Perforatoren bei der mikrovaskulären Brustrekonstruktion

 

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Zusammenfassung

Hintergrund Die Thermographie gewährleistet eine nicht-invasive Darstellung von Temperaturdifferenzen. Bei mikrovaskulären Lappenplastiken könnte die Thermographie kutane Temperaturdifferenzen aufzeigen und somit indirekt Durchblutungsmuster über Perforatoren darstellen. Bei der präoperativen Planung könnte diese Methode als zusätzliches Tool die Qualität und Vielfältigkeit der freien Lappenplastiken steigern.

Patienten und Methoden 10 Patientinnen mit 13 freien DIEP-Lappenplastiken zur Brustrekonstruktion wurden in dieser prospektiven Studie untersucht. Mittels Smartphone-basierter Thermographie wurden präoperativ die „hot spots“ der Hautdurchblutung (Perforatoreintritt) am Abdomen dargestellt. Die Ergebnisse wurden mit der präoperativ durchgeführten Computertomographischen-Angiographie (CTA), sowie der intraoperativen Anatomie verglichen.

Ergebnisse Die Thermographie konnte bei allen Patienten erfolgreich eingesetzt werden und zeigte verlässlich Perfusionsareale mit „hot spots“ im Hebeareal. Alle präoperativ am Abdomen thermographisch ausgewählten Hauptperforatoren wurden auch intraoperativ zur DIEP-Lappenplastik verwendet. Die Auswahl der Hauptperforatoren deckte sich dabei auch mit den Ergebnissen der CTA-Untersuchungen.

Schlussfolgerung Die Smartphone-basierte Thermographie kann einfach, schnell und nicht-invasiv kutane Temperaturdifferenzen darstellen. Die Darstellung des Perforatoreintritts in die Haut ist über die sichtbaren Wärmepunkte zuverlässig möglich. Bei der Auswahl eines geeigneten Perforators bringt die Thermographie nützliche Zusatzinformationen und ist somit ein ergänzendes Tool in der Bildgebung der Perforator-basierten Lappenplastiken.

Abstract

Background Thermography permits non-invasive examination and presentation of cutaneous temperature differences. When planning microvascular flaps, thermography may illustrate these differences and may portray patterns of blood circulation near to perforators. As an additional tool, thermography may enhance quality and diversity in free flaps.

Patients and Methods In this prospective study, we examined 10 patients with 13 free DIEP-flaps for breast reconstruction. With smartphone-based thermography, we analysed preoperative abdominal “hot spots” of skin circulation (entrance of perforators). The results were compared with preoperative computed tomographic angiography (CTA) and intraoperative anatomical findings.

Results Thermography was succesfully performed on all patients. Areas of perfusion were reliably shown in the raised area (“hot spot”). Each perforator selected by thermography was also selected for the DIEP free flap on the basis of intraoperative findings. Moreover, the identified main perforators were identical to perforators found at the CTA.

Conclusion Smartphone-based thermography provides an easy, rapid and non-invasive method to present cutaneous differences in temperature. “Hot spots” can reliably illustrate the entrance of perforators. When selecting a suitable perforator, thermography provides additional information for imaging perforator-based flaps.

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