Subscribe to RSS
DOI: 10.1055/s-0042-1755614
Thermography Supported Color Duplex Ultrasound Accelerates ALT Perforator Imaging
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.
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
- 2 Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2003; 50 (01) 90-99
- 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
- 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
- 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
- 6 Chen HH, Lin MS, Chou EK. et al. Anterolateral thigh perforator flap: varying perforator anatomy. Ann Plast Surg 2009; 63 (02) 153-155
- 7 Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA. Anterolateral thigh free flap. Ann Plast Surg 1995; 34 (06) 585-592
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 16 de Weerd L, Mercer JB, Weum S. Dynamic infrared thermography. Clin Plast Surg 2011; 38 (02) 277-292
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 29 Sheena Y, Jennison T, Hardwicke JT, Titley OG. Detection of perforators using thermal imaging. Plast Reconstr Surg 2013; 132 (06) 1603-1610
- 30 Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging. Plast Reconstr Surg 2016; 137 (01) 39-41
- 31 Pereira N, Hallock GG. Smartphone thermography for lower extremity local flap perforator mapping. J Reconstr Microsurg 2021; 37 (01) 59-66
- 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
- 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
- 34 Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir 2002; 34 (04) 239-244
- 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
- 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
- 37 Uppot RN. Technical challenges of imaging & image-guided interventions in obese patients. Br J Radiol 2018; 91 (1089): 20170931
- 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
- 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
- 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
- 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