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DOI: 10.1055/s-0041-1731641
Air Flow Cooling Improves Anterolateral Thigh Perforator Mapping Using the FLIR ONE Thermal Camera
Abstract
Background Due to the variable vascular anatomy preoperative perforator mapping facilitates anterolateral thigh (ALT) free flap harvesting. Dynamic infrared perforator imaging can assist preoperative planning by displaying hot spots that represent angiosomes. This study aims to compare previously described precooling methods to develop a standardized simplified protocol for ALT perforator planning.
Methods Fifty thighs were examined with a FLIR ONE thermal camera. Four different cold challenges, including alcoholic disinfection, wet laparotomy sponge cooling, fan cooling, and cold pack application, were compared. Hot spot locations within a 250 mm × 80 mm area were compared double-blinded to perforator locations determined by Doppler ultrasonography considered as gold standard.
Results The matching rate of thermographic hot spots and sonographically identified perforators was 34.9 ± 22.2%. An increased matching rate of 62.2 ± 42.2% was noted taking only favored perforators (septocutaneous course, diameter >1 mm, distance <3 cm to the center, and visible concomitant veins) into account. Precooling with a fan followed by alcoholic disinfection provided clearest thermograms and fastest results.
Conclusion Thermographic imaging is a reliable method for perforator imaging. Its supplemental use to ultrasound may reduce examination time and yield additional information. Precooling by air flow or alcoholic disinfection can be easily implemented and provide the best thermograms. The matching rate of thermographic hot spots and perforators increases when taking only clinically relevant perforators into account. Thermal perforator mapping therefore reduces distraction by negligible perforators.
Publikationsverlauf
Eingereicht: 17. Januar 2021
Angenommen: 12. Mai 2021
Artikel online veröffentlicht:
06. Juli 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
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References
- 1 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159
- 2 Ozkan O, Coşkunfirat OK, Ozgentaş HE. The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann Plast Surg 2004; 53 (05) 455-461
- 3 Demirkan F, Chen HC, Wei FC. et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000; 53 (01) 30-36
- 4 Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006; 59 (02) 153-157
- 5 Mureau MAM, Posch NAS, Meeuwis CA, Hofer SOP. Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient- and donor-site outcome. Plast Reconstr Surg 2005; 115 (04) 1077-1086
- 6 Fischer S, Diehm Y, Hirche C. et al. Comparison of sub- versus suprafascially raised anterolateral thigh free flaps with regard to donor-site morbidity, function and aesthetics. Microsurgery 2018; 38 (05) 444-449
- 7 Saint-Cyr M, Schaverien M, Wong C. et al. The extended anterolateral thigh flap: anatomical basis and clinical experience. Plast Reconstr Surg 2009; 123 (04) 1245-1255
- 8 Nojima K, Brown SA, Acikel C. et al. Defining vascular supply and territory of thinned perforator flaps: part I. Anterolateral thigh perforator flap. Plast Reconstr Surg 2005; 116 (01) 182-193
- 9 Cherubino M, Stocco C, Ronga M. et al. Comparisons of fascio-cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction. Microsurgery 2020; 40 (04) 452-459
- 10 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141
- 11 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (05) 1529-1544
- 12 Seth R, Manz RM, Dahan IJ. et al. Comprehensive analysis of the anterolateral thigh flap vascular anatomy. Arch Facial Plast Surg 2011; 13 (05) 347-354
- 13 Smith RK, Wykes J, Martin DT, Niles N. Perforator variability in the anterolateral thigh free flap: a systematic review. Surg Radiol Anat 2017; 39 (07) 779-789
- 14 Uppal RS, Casaer B, Van Landuyt K, Blondeel P. The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg 2009; 62 (07) 859-864
- 15 Pereira N, Hallock GG. Smartphone thermography for lower extremity local flap perforator mapping. J Reconstr Microsurg 2021; 37 (01) 59-66
- 16 Iida H, Ohashi I, Kishimoto S, Umeda T, Hata Y. Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry. Br J Plast Surg 2003; 56 (01) 21-25
- 17 Yang JF, Wang BY, Zhao ZH, Zhou P, Pang F, Sun WD. Clinical applications of preoperative perforator planning using CT angiography in the anterolateral thigh perforator flap transplantation. Clin Radiol 2013; 68 (06) 568-573
- 18 Jiang C, Lin P, Fu X. et al. Three-dimensional contrast-enhanced magnetic resonance angiography for anterolateral thigh flap outlining: a retrospective case series of 68 patients. Exp Ther Med 2016; 12 (02) 1067-1074
- 19 Daigeler A, Schubert C, Hirsch T, Behr B, Lehnhardt M. [Colour duplex sonography and “Power-Duplex” in Perforator Surgery - Improvement of patients safety by efficient planning] (in German). Handchir Mikrochir Plast Chir 2018; 50 (02) 101-110
- 20 Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007; 357 (22) 2277-2284
- 21 Golusiński P, Luczewski Ł, Pazdrowski J. et al. The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap. Eur Arch Otorhinolaryngol 2014; 271 (05) 1241-1247
- 22 Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging. Plast Reconstr Surg 2016; 137 (01) 39-41
- 23 Weum S, Mercer JB, de Weerd L. Evaluation of dynamic infrared thermography as an alternative to CT angiography for perforator mapping in breast reconstruction: a clinical study. BMC Med Imaging 2016; 16 (01) 43
- 24 de Weerd L, Mercer JB, Setså LB. Intraoperative dynamic infrared thermography and free-flap surgery. Ann Plast Surg 2006; 57 (03) 279-284
- 25 Cruz-Segura A, Cruz-Domínguez MP, Jara LJ. et al. Early detection of vascular obstruction in microvascular flaps using a thermographic camera. J Reconstr Microsurg 2019; 35 (07) 541-548
- 26 Fraiwan L, Ninan J, Al-Khodari M. Mobile application for ulcer detection. Open Biomed Eng J 2018; 12: 16-26
- 27 Jaspers MEH, Carrière ME, Meij-de Vries A, Klaessens JHGM, van Zuijlen PPM. The FLIR ONE thermal imager for the assessment of burn wounds: Reliability and validity study. Burns 2017; 43 (07) 1516-1523
- 28 Arai K, Fukuda O. [Clinical application of thermometers and thermography in plastic surgery] (in Japanese). Keisei Geka 1968; 11 (03) 239-250
- 29 Theuvenet WJ, Koeyers GF, Borghouts MH. Thermographic assessment of perforating arteries. A preoperative screening method for fasciocutaneous and musculocutaneous flaps. Scand J Plast Reconstr Surg 1986; 20 (01) 25-29
- 30 Pereira N, Valenzuela D, Mangelsdorff G, Kufeke M, Roa R. Detection of perforators for free flap planning using smartphone thermal imaging: a concordance study with computed tomographic angiography in 120 perforators. Plast Reconstr Surg 2018; 141 (03) 787-792
- 31 de Weerd L, Weum S, Mercer JB. The value of dynamic infrared thermography (DIRT) in perforatorselection and planning of free DIEP flaps. Ann Plast Surg 2009; 63 (03) 274-279
- 32 Tenorio X, Mahajan AL, Elias B. et al. Locating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge. Ann Plast Surg 2011; 67 (02) 143-146
- 33 Mercer JB, Weerd L, Weum S. Thermography in plastic surgery. Thermol Int 2012; 22 (03) 9-15
- 34 Niepel AL, Dominik S, Lewicki M. et al. Decision between contralateral and ipsilateral DIEP flap harvesting for unilateral breast reconstruction. Eur J Plast Surg 2019; 42: 29-32
- 35 Walle L, Fansa H, Frerichs O. [Smartphone-based thermography for perforator localisation in microvascular breast reconstruction] (in german). Handchir Mikrochir Plast Chir 2018; 50 (02) 111-117
- 36 Ko WS, Chiu T. Detection of perforators using smartphone thermal imaging. Plast Reconstr Surg 2016; 138 (02) 380e-381e
- 37 Cifuentes IJ, Dagnino BL, Salisbury MC, Perez ME, Ortega C, Maldonado D. Augmented reality and dynamic infrared thermography for perforator mapping in the anterolateral thigh. Arch Plast Surg 2018; 45 (03) 284-288
- 38 Muntean MV, Strilciuc S, Ardelean F. et al. Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators. Med Ultrason 2015; 17 (04) 503-508
- 39 Chubb D, Rozen WM, Whitaker IS, Ashton MW. Images in plastic surgery: digital thermographic photography (“thermal imaging”) for preoperative perforator mapping. Ann Plast Surg 2011; 66 (04) 324-325
- 40 Thiessen FEF, Tondu T, Vermeersch N. et al. Dynamic infrared thermography (DIRT) in deep inferior epigastric perforator (DIEP) flap breast reconstruction: standardization of the measurement set-up. Gland Surg 2019; 8 (06) 799-805
- 41 Chubb DP, Taylor GI, Ashton MW. True and ‘choke’ anastomoses between perforator angiosomes: part II. Dynamic thermographic identification. Plast Reconstr Surg 2013; 132 (06) 1457-1464
- 42 Chijiwa T, Arai K, Miyazaki N, Igota S, Yamamoto N. Making of a facial perforator map by thermography. Ann Plast Surg 2000; 44 (06) 596-600
- 43 Sheena Y, Jennison T, Hardwicke JT, Titley OG. Detection of perforators using thermal imaging. Plast Reconstr Surg 2013; 132 (06) 1603-1610
- 44 Munhoz AM, Ishida LH, Sturtz GP. et al. Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting. Plast Reconstr Surg 2004; 113 (02) 517-524