Evaluating Surgical Delay Using Infrared Thermography in an Island Pedicled Perforator Flap Rat Model

Abstract

Background The aim of this study was to examine the usefulness of infrared (IR) thermography in visualizing the dilation of the choke vessels in a delayed pedicled perforator flap rat model.

Methods A three-territory island flap was designed and harvested on one side of the rat dorsum. The flap was divided into five regions. In the normal group (n = 8), IR thermal imaging was correlated with the postmortem arteriography for the location of angiosomes, linking patterns, perforator diameter, and temperature on each region. The delay group (n = 35) was divided into seven groups according to various delay periods. At different time intervals, the delay group was compared with the normal group according to link pattern and temperature on each region.

Results IR thermal imaging showed that a white hotspot existed on the surface of each angiosome; the true anastomotic vessels manifested a continuous white band linking the white hotspots on angiosomes, whereas the choke vessels presented a red zone in between adjacent hotspots. After delay, the dilation of the choke vessels manifested itself as the replacement of the red zone between adjacent hotspots by the white band on IR thermography. In addition, the delayed flap presented a phenomenon of rise and fall in temperature over time.

Conclusion IR thermography can accurately visualize the process of the dilation of choke vessels after a surgical delay. The chronological change in the IR thermal imaging combined with the temperature change in the delayed flap might be useful to determine the optimal delay period.

Keywords

delay phenomenon - infrared thermography - pedicled perforator flap

Funding

This work was supported by the National Natural Science Foundation of China (No. 81472062).

• References

• 1 Morris SF, Taylor GI. The time sequence of the delay phenomenon: when is a surgical delay effective? An experimental study. Plast Reconstr Surg 1995; 95 (03) 526-533
• 2 Xu H, Zhang Z, Tao W. , et al. Ex vivo delay: a novel approach to increase prefabricated flaps survival rate. J Reconstr Microsurg 2016; 32 (08) 632-638
• 3 Cinpolat A, Bektas G, Coskunfirat N, Rizvanovic Z, Coskunfirat OK. Comparing various surgical delay methods with ischemic preconditioning in the rat TRAM flap model. J Reconstr Microsurg 2014; 30 (05) 335-342
• 4 Yang D, Morris SF. Comparison of two different delay procedures in a rat skin flap model. Plast Reconstr Surg 1998; 102 (05) 1591-1597
• 5 Taylor GI, Minabe T. The angiosomes of the mammals and other vertebrates. Plast Reconstr Surg 1992; 89 (02) 181-215
• 6 Tang M, Geddesÿ CR, Daping YaSFM. Modified lead oxide-gelatin technique for vascular studies. J Clin Anat (Chinese Society for Anatomical Sciences) 2002; 1: 73-78
• 7 Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction?. Clin Orthop Relat Res 2014; 472 (07) 2276-2286
• 8 D'Arpa S, Cordova A, Pignatti M, Moschella F. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg 2011; 128 (04) 892-906
• 9 de Weerd L, Mercer JB, Weum S. Dynamic infrared thermography. Clin Plast Surg 2011; 38 (02) 277-292
• 10 de Weerd L, Miland AO, Mercer JB. Perfusion dynamics of free DIEP and SIEA flaps during the first postoperative week monitored with dynamic infrared thermography. Ann Plast Surg 2009; 62 (01) 42-47
• 11 Sheena Y, Jennison T, Hardwicke JT, Titley OG. Detection of perforators using thermal imaging. Plast Reconstr Surg 2013; 132 (06) 1603-1610
• 12 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
• 13 Nasser A, Fourman MS, Gersch RP. , et al. Utilizing indocyanine green dye angiography to detect simulated flap venous congestion in a novel experimental rat model. J Reconstr Microsurg 2015; 31 (08) 590-596
• 14 Holm C, Mayr M, Höfter E, Becker A, Pfeiffer UJ, Mühlbauer W. Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 2002; 55 (08) 635-644
• 15 Cederna PS, Chang P, Pittet-Cuenod BM, Razaboni RM, Cram AE. The effect of the delay phenomenon on the vascularity of rabbit abdominal cutaneous island flaps. Plast Reconstr Surg 1997; 99 (01) 183-193
• 16 Holzbach T, Neshkova I, Vlaskou D. , et al. Searching for the right timing of surgical delay: angiogenesis, vascular endothelial growth factor and perfusion changes in a skin-flap model. J Plast Reconstr Aesthet Surg 2009; 62 (11) 1534-1542
• 17 Ghali S, Butler PE, Tepper OM, Gurtner GC. Vascular delay revisited. Plast Reconstr Surg 2007; 119 (06) 1735-1744