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J Reconstr Microsurg 2023; 39(04): 295-300
DOI: 10.1055/s-0042-1755614
Original Article

Thermography Supported Color Duplex Ultrasound Accelerates ALT Perforator Imaging

Claudius Illg 
1   Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
,
Sabrina Krauss
1   Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
,
Katarzyna Rachunek
1   Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
,
Johannes Tobias Thiel
1   Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
,
Adrien Daigeler
1   Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
,
Ruth Christine Schäfer
1   Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany
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Abstract

Background The anterolateral thigh flap is a versatile and dependable perforator flap and is a popular choice in the reconstruction of various body sites. The variable perforator anatomy suggests preoperative perforator imaging to improve safety and speed of dissection. An innovative perforator imaging technique is thermography, which lately gained attention in plastic surgery.

Methods Thirty-two healthy participants were included in this randomized study. One thigh was examined with dynamic infrared thermography and consecutively with ultrasound, while the contralateral thigh was examined with ultrasound as standalone technology.

Results The application of dynamic infrared thermography prior to ultrasound perforator identification significantly accelerated the ultrasound examination duration by 90 to 130 seconds. The mean duplex ultrasound examination duration correlated positively with the hotspot and perforator quantity per thigh.

Conclusion The addition of thermographic perforator mapping can accelerate color duplex ultrasound anterolateral thigh perforator imaging. Furthermore, thermography supplements color duplex ultrasound with crucial information on angiosome location.

Keywords

ALT flap - perforator - thermography


Publication History

Received: 23 February 2022

Accepted: 23 June 2022

Article published online:
23 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
    CrossrefPubMedSearch in Google Scholar
  • 2 Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2003; 50 (01) 90-99
    CrossrefPubMedSearch in Google Scholar
  • 3 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
    CrossrefPubMedSearch in Google Scholar
  • 4 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (07) 2219-2226 , discussion 2227–2230
    CrossrefPubMedSearch in Google Scholar
  • 5 Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 2012; 130 (06) 1254-1268
    CrossrefPubMedSearch in Google Scholar
  • 6 Chen HH, Lin MS, Chou EK. et al. Anterolateral thigh perforator flap: varying perforator anatomy. Ann Plast Surg 2009; 63 (02) 153-155
    CrossrefPubMedSearch in Google Scholar
  • 7 Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh free flap. Ann Plast Surg 1995; 34 (06) 585-592
    CrossrefPubMedSearch in Google Scholar
  • 8 Wei FC, Jain V, Suominen S, Chen HC. Confusion among perforator flaps: what is a true perforator flap?. Plast Reconstr Surg 2001; 107 (03) 874-876
    CrossrefPubMedSearch in Google Scholar
  • 9 Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998; 102 (05) 1517-1523
    CrossrefPubMedSearch in Google Scholar
  • 10 Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg 1989; 42 (03) 260-262
    CrossrefPubMedSearch in Google Scholar
  • 11 Kim JT. Two options for perforator flaps in the flank donor site: latissimus dorsi and thoracodorsal perforator flaps. Plast Reconstr Surg 2005; 115 (03) 755-763
    CrossrefPubMedSearch in Google Scholar
  • 12 Wade RG, Razzano S, Sassoon EM, Haywood RM, Ali RS, Figus A. Complications in DIEP flap breast reconstruction after mastectomy for breast cancer: a prospective cohort study comparing unilateral versus bilateral reconstructions. Ann Surg Oncol 2017; 24 (06) 1465-1474
    CrossrefPubMedSearch in Google Scholar
  • 13 Wade RG, Watford J, Wormald JCR, Bramhall RJ, Figus A. Perforator mapping reduces the operative time of DIEP flap breast reconstruction: a systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography. J Plast Reconstr Aesthet Surg 2018; 71 (04) 468-477
    CrossrefPubMedSearch in Google Scholar
  • 14 Cheng H, Clymer JW, Po-Han Chen B. et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 2018; 229: 134-144
    CrossrefPubMedSearch in Google Scholar
  • 15 Nassar AH, Maselli AM, Manstein S. et al. Comparison of various modalities utilized for preoperative planning in microsurgical reconstructive surgery. J Reconstr Microsurg 2022; 38 (03) 170-180
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 de Weerd L, Mercer JB, Weum S. Dynamic infrared thermography. Clin Plast Surg 2011; 38 (02) 277-292
    CrossrefPubMedSearch in Google Scholar
  • 17 Ritschl LM, Fichter AM, Bomhard AV. et al. Comparison between different perforator imaging modalities for the anterolateral thigh perforator flap transfer: a prospective study. J Reconstr Microsurg 2020; 36 (09) 686-693
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Illg C, Krauss S, Rothenberger J, Kolbenschlag J, Daigeler A, Schäfer RC. Air flow cooling improves anterolateral thigh perforator mapping using the FLIR ONE thermal camera. J Reconstr Microsurg 2022; 38 (02) 144-150
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Taylor GI, Chubb DP, Ashton MW. True and ‘choke’ anastomoses between perforator angiosomes: part i. Anatomical location. Plast Reconstr Surg 2013; 132 (06) 1447-1456
    CrossrefPubMedSearch in Google Scholar
  • 20 Hennessy O, McLoughlin R, McInerney N, Hussey A, Potter S. Smartphone thermal imaging for preoperative perforator mapping in DIEP flap breast reconstruction. Eur J Plast Surg 2020; 43 (06) 743-750
    CrossrefPubMedSearch in Google Scholar
  • 21 Lindsey Jr JT, Smith C, Lee J, St Hilaire H, Lindsey Sr JT. Mapping 216 perforator flaps using highly portable tablet-based color Doppler ultrasound (PT-CDU). J Reconstr Microsurg 2022; 38 (02) 115-120
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Perez-Iglesias CT, Laikhter E, Kang CO. et al. Current applications of ultrasound imaging in the preoperative planning of DIEP flaps. J Reconstr Microsurg 2022; 38 (03) 221-227
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Kehrer A, Sachanadani NS, da Silva NPB. et al. Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - basic and advanced applications and device settings. J Plast Reconstr Aesthet Surg 2020; 73 (06) 1081-1090
    CrossrefPubMedSearch in Google Scholar
  • 24 Debelmas A, Camuzard O, Aguilar P, Qassemyar Q. Reliability of color Doppler ultrasound imaging for the assessment of anterolateral thigh flap perforators: a prospective study of 30 perforators. Plast Reconstr Surg 2018; 141 (03) 762-766
    CrossrefPubMedSearch in Google Scholar
  • 25 Feng S, Min P, Grassetti L. et al. A prospective head-to-head comparison of color Doppler ultrasound and computed tomographic angiography in the preoperative planning of lower extremity perforator flaps. Plast Reconstr Surg 2016; 137 (01) 335-347
    CrossrefPubMedSearch in Google Scholar
  • 26 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
    PubMedSearch in Google Scholar
  • 27 Vijayasekaran A, Gibreel W, Carlsen BT. et al. Maximizing the utility of the pedicled anterolateral thigh flap for locoregional reconstruction: technical pearls and pitfalls. Clin Plast Surg 2020; 47 (04) 621-634
    CrossrefPubMedSearch in Google Scholar
  • 28 John HE, Niumsawatt V, Rozen WM, Whitaker IS. Clinical applications of dynamic infrared thermography in plastic surgery: a systematic review. Gland Surg 2016; 5 (02) 122-132
    PubMedSearch in Google Scholar
  • 29 Sheena Y, Jennison T, Hardwicke JT, Titley OG. Detection of perforators using thermal imaging. Plast Reconstr Surg 2013; 132 (06) 1603-1610
    CrossrefPubMedSearch in Google Scholar
  • 30 Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging. Plast Reconstr Surg 2016; 137 (01) 39-41
    CrossrefPubMedSearch in Google Scholar
  • 31 Pereira N, Hallock GG. Smartphone thermography for lower extremity local flap perforator mapping. J Reconstr Microsurg 2021; 37 (01) 59-66
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 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
    CrossrefPubMedSearch in Google Scholar
  • 33 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir 2002; 34 (04) 239-244
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 Choi SW, Park JY, Hur MS. et al. An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg 2007; 18 (04) 866-871
    CrossrefPubMedSearch in Google Scholar
  • 36 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
    CrossrefPubMedSearch in Google Scholar
  • 37 Uppot RN. Technical challenges of imaging & image-guided interventions in obese patients. Br J Radiol 2018; 91 (1089): 20170931
    CrossrefPubMedSearch in Google Scholar
  • 38 Yin J, Wang L, Yang G, Qin X, Xiong P. Correlation between body mass index and anterolateral thigh flap thickness: a retrospective study from a single center in China. Front Surg 2021; 8: 748799
    CrossrefPubMedSearch in Google Scholar
  • 39 Ranosz-Janicka I, Lis-Święty A, Skrzypek-Salamon A, Brzezińska-Wcisło L. Detecting and quantifying activity/inflammation in localized scleroderma with thermal imaging. Skin Res Technol 2019; 25 (02) 118-123
    CrossrefPubMedSearch in Google Scholar
  • 40 Schuster A, Thielecke M, Raharimanga V. et al. High-resolution infrared thermography: a new tool to assess tungiasis-associated inflammation of the skin. Trop Med Health 2017; 45: 23
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar