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

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

doi:10.1016/j.jpra.2023.08.004

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

JPRAS Open. 2023 Aug 21:38:98-108. doi: 10.1016/j.jpra.2023.08.004. eCollection 2023 Dec.

Authors

Ahmed M Yassin^{1

2

3}, Muholan Kanapathy^{2

3}, Amr M E Khater¹, Ahmed Hassan El-Sabbagh¹, Omar Shouman¹, Dariush Nikkhah^{2

3}, Afshin Mosahebi^{2

3}

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Mansoura University, Egypt.
² Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom.
³ Division of Surgery & Interventional Science, University College London, London, United Kingdom.

Abstract

Introduction: In this study, we evaluate the versatility of smartphone thermal imaging technology as a valuable intraoperative modality in different stages of perforator flap surgery aiming to minimize the complications and achieve the best postoperative outcome.

Patients and methods: Thermography was performed in 20 perforator flaps in 20 patients at different surgical stages in three different ways to identify the most dominant perforator: first, by measuring the surface temperature of the skin; second, by using the dynamic infrared thermography technique; and third, by assessing the perfusion pattern when the flap was supplied by each perforator separately. Thermography was used to help in discarding the least perfused area of the flap. After microvascular anastomosis, the flap reheating pattern was evaluated.

Results: Seventeen free and three pedicled perforator flaps were included. Intraoperatively, each of the selected perforators had a corresponding hotspot. The perforator with the hottest hotpot, best rewarming, and provision of best flap perfusion on thermography was found clinically dominant. After microvascular anastomosis in free flaps, rapid rewarming was recorded in 15 cases. In two deep inferior epigastric perforator flaps, no rapid rewarming was observed. The pedicle was kinked in one case and there was a venous insufficiency in another case that required a cephalic turndown. All flaps showed good perfusion on thermography after inset.

Conclusion: Smartphone thermography has proven to be a valuable, cheap, rapidly employed, and objective tool not only for the design of perforator flaps, but also for the decision making intraoperatively to achieve the best surgical outcome.

Keywords: DIEP flaps; Thermography; microsurgery; perforator flaps.