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De La Hoz EC, Verstockt J, Verspeek S, Clarys W, Thiessen FEF, Tondu T, Tjalma WAA, Steenackers G, Vanlanduit S. Automated thermographic detection of blood vessels for DIEP flap reconstructive surgery. Int J Comput Assist Radiol Surg 2024; 19:1733-1741. [PMID: 39014178 DOI: 10.1007/s11548-024-03199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/27/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE Inadequate perfusion is the most common cause of partial flap loss in tissue transfer for post-mastectomy breast reconstruction. The current state-of-the-art uses computed tomography angiography (CTA) to locate the best perforators. Unfortunately, these techniques are expensive and time-consuming and not performed during surgery. Dynamic infrared thermography (DIRT) can offer a solution for these disadvantages. METHODS The research presented couples thermographic examination during DIEP flap breast reconstruction with automatic segmentation approach using a convolutional neural network. Traditional segmentation techniques and annotations by surgeons are used to create automatic labels for the training. RESULTS The network used for image annotation is able to label in real-time on minimal hardware and the labels created can be used to locate and quantify perforator candidates for selection with a dice score accuracy of 0.8 after 2 min and 0.9 after 4 min. CONCLUSIONS These results allow for a computational system that can be used in place during surgery to improve surgical success. The ability to track and measure perforators and their perfused area allows for less subjective results and helps the surgeon to select the most suitable perforator for DIEP flap breast reconstruction.
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Affiliation(s)
- Edgar Cardenas De La Hoz
- InViLab Research Group, Faculty of Applied Engineering, University of Antwerp, Groenenborgerlaan 171, 2020, Wilrijk, Antwerp, Belgium.
| | - Jan Verstockt
- InViLab Research Group, Faculty of Applied Engineering, University of Antwerp, Groenenborgerlaan 171, 2020, Wilrijk, Antwerp, Belgium
| | - Simon Verspeek
- InViLab Research Group, Faculty of Applied Engineering, University of Antwerp, Groenenborgerlaan 171, 2020, Wilrijk, Antwerp, Belgium
| | - Warre Clarys
- InViLab Research Group, Faculty of Applied Engineering, University of Antwerp, Groenenborgerlaan 171, 2020, Wilrijk, Antwerp, Belgium
| | - Filip E F Thiessen
- Department of Plastic, Reconstructive and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, Wilrijkstraat 10, 2650, Antwerp, Antwerp, Belgium
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ziekenhuis Netwerk Antwerpen, Lindendreef 1, 2020, Antwerp, Antwerp, Belgium
| | - Thierry Tondu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Multidisciplinary Breast Clinic, Antwerp University Hospital, Wilrijkstraat 10, 2650, Antwerp, Antwerp, Belgium
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ziekenhuis Netwerk Antwerpen, Lindendreef 1, 2020, Antwerp, Antwerp, Belgium
| | - Wiebren A A Tjalma
- Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, Wilrijkstraat 10, 2650, Antwerp, Antwerp, Belgium
| | - Gunther Steenackers
- InViLab Research Group, Faculty of Applied Engineering, University of Antwerp, Groenenborgerlaan 171, 2020, Wilrijk, Antwerp, Belgium
| | - Steve Vanlanduit
- InViLab Research Group, Faculty of Applied Engineering, University of Antwerp, Groenenborgerlaan 171, 2020, Wilrijk, Antwerp, Belgium
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Unger M, Hänel A, Chalopin C, Halama D. Design and evaluation of an AR-based thermal imaging system for planning reconstructive surgeries. Int J Comput Assist Radiol Surg 2024; 19:1659-1666. [PMID: 38789883 DOI: 10.1007/s11548-024-03184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Thermal imaging can be used for the non-invasive detection of blood vessels of the skin. However, mapping the results to the patient currently lacks user-friendliness. Augmented reality may provide a useful tool to superimpose thermal information on the patient. METHODS A system to support planning in reconstructive surgery using a thermal camera was designed. The obtained information was superimposed on the physical object using a Microsoft HoloLens. An RGB, depth, and thermal camera were combined to capture a scene of different modalities and reconstruct a virtual scene in real time. To register the different cameras and the AR device, an active calibration target was developed and evaluated. A Vuforia marker was used to register the hologram in the virtual space. The accuracy of the projected hologram was evaluated in a laboratory setting with participants by measuring the error between the physical object and the hologram. RESULTS The AR-based system was evaluated by 21 participants in a laboratory setting. The mean projection error is 10.3 ± 9.4 mm. The system is able to stream a three-dimensional scene with augmented thermal information in real time at 5 frames per second. The active calibration target can be used independently of the environment. CONCLUSION The calibration target provides an easy-to-use method for the registration of cameras capturing the visible to long-infrared spectral range. The inside-out tracking of the HoloLens in combination with a Vuforia marker is not accurate enough for the intended clinical use.
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Affiliation(s)
- Michael Unger
- Innovation Center Computer Assisted Surgery, Leipzig, Germany.
| | - Annika Hänel
- Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery, Leipzig, Germany
- University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Göttingen, Germany
| | - Dirk Halama
- Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital Leipzig, Leipzig, Germany
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Kim HH, Song IS, Cha RJ. Advancing DIEP Flap Monitoring with Optical Imaging Techniques: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:4457. [PMID: 39065854 PMCID: PMC11280549 DOI: 10.3390/s24144457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This review aims to explore recent advancements in optical imaging techniques for monitoring the viability of Deep Inferior Epigastric Perforator (DIEP) flap reconstruction. The objectives include highlighting the principles, applications, and clinical utility of optical imaging modalities such as near-infrared spectroscopy (NIRS), indocyanine green (ICG) fluorescence angiography, laser speckle contrast imaging (LSCI), hyperspectral imaging (HSI), dynamic infrared thermography (DIRT), and short-wave infrared thermography (SWIR) in assessing tissue perfusion and oxygenation. Additionally, this review aims to discuss the potential of these techniques in enhancing surgical outcomes by enabling timely intervention in cases of compromised flap perfusion. MATERIALS AND METHODS A comprehensive literature review was conducted to identify studies focusing on optical imaging techniques for monitoring DIEP flap viability. We searched PubMed, MEDLINE, and relevant databases, including Google Scholar, Web of Science, Scopus, PsycINFO, IEEE Xplore, and ProQuest Dissertations & Theses, among others, using specific keywords related to optical imaging, DIEP flap reconstruction, tissue perfusion, and surgical outcomes. This extensive search ensured we gathered comprehensive data for our analysis. Articles discussing the principles, applications, and clinical use of NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR in DIEP flap monitoring were selected for inclusion. Data regarding the techniques' effectiveness, advantages, limitations, and potential impact on surgical decision-making were extracted and synthesized. RESULTS Optical imaging modalities, including NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation in DIEP flap reconstruction. These techniques provide objective and quantitative data, enabling surgeons to monitor flap viability accurately. Studies have demonstrated the effectiveness of optical imaging in detecting compromised perfusion and facilitating timely intervention, thereby reducing the risk of flap complications such as partial or total loss. Furthermore, optical imaging modalities have shown promise in improving surgical outcomes by guiding intraoperative decision-making and optimizing patient care. CONCLUSIONS Recent advancements in optical imaging techniques present valuable tools for monitoring the viability of DIEP flap reconstruction. NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation, enabling accurate evaluation of flap viability. These modalities have the potential to enhance surgical outcomes by facilitating timely intervention in cases of compromised perfusion, thereby reducing the risk of flap complications. Incorporating optical imaging into clinical practice can provide surgeons with objective and quantitative data, assisting in informed decision-making for optimal patient care in DIEP flap reconstruction surgeries.
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Affiliation(s)
- Hailey Hwiram Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (H.H.K.); (R.J.C.)
| | - In-Seok Song
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (H.H.K.); (R.J.C.)
- Department of Oral & Maxillofacial Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Richard Jaepyeong Cha
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA; (H.H.K.); (R.J.C.)
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
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Lin HY, Bu X, Yang X, Zhen YH, Li D, Zhao ZM, An Y. Repair of Asian nasal subunit defects using nasolabial perforator flaps: A retrospective study. J Cosmet Dermatol 2024; 23:630-638. [PMID: 37846506 DOI: 10.1111/jocd.16032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons. AIMS To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re-operation. PATIENTS/METHODS This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5-point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re-operation. RESULTS The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm2 to 40 × 70 mm2 , and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re-operation (p = 0.004), but no risk factor was associated with complications. CONCLUSIONS The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners.
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Affiliation(s)
- Hong-Ying Lin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Xi Bu
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yong-Huan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Dong Li
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Zhen-Min Zhao
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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Ismail S, Zulfiqar B, Sami W, Gulzar S, Akhlaq F, Naz E, Rupani S. Smartphone Thermal Imaging for Preoperative Perforator Mapping in Perforator Based Flaps. Cureus 2024; 16:e51755. [PMID: 38318547 PMCID: PMC10842339 DOI: 10.7759/cureus.51755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To determine the diagnostic accuracy of smartphone thermal imaging for preoperative perforator mapping in perforator-based flaps, taking visual inspection as gold standard. METHODOLOGY It was a cross-validation study conducted at the Department of Plastic Surgery, Dr. Ruth K. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. All adult patients aged 18 to 40 years of either gender undergoing perforator flap surgery were included. Each patient followed the same treatment regimen, which involved the preoperative identification of the perforator location using the FLIR One camera. Subsequently, confirmation was achieved during the surgical procedure through visual inspection. A two-by two table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. RESULTS The mean age of the patients was 30.10±6.87 years, ranging from 18 to 40 years. Most of the patients were males (58.7%), and 41.3% were females. Almost 80.4% were pedicle flaps, and 19.6% were free flaps. The accuracy of thermal imaging was found to be 83.2%, with a sensitivity of 84.3%, a specificity of 80%, a PPV of 92.9%, and a NPV of 62.2%, respectively. CONCLUSION Smartphone-based thermal imaging is useful for the diagnosis of perforators and has high sensitivity and specificity.
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Affiliation(s)
- Sarosh Ismail
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Bushra Zulfiqar
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Waqas Sami
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Sadaf Gulzar
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Faisal Akhlaq
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Erum Naz
- Department of Plastic Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Sukaina Rupani
- Department of General Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
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郭 蕴, 崔 文, 宗 开, 李 建, 孙 悦, 胡 恺, 陈 默, 江 如. [Application of infrared thermography technique to assist peroneal artery perforator flap in the repair of oral and maxillofacial defects]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1015-1020. [PMID: 35979795 PMCID: PMC9379453 DOI: 10.7507/1002-1892.202205032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/19/2022] [Indexed: 01/24/2023]
Abstract
Objective To explore the application value of infrared thermography (IRT) technique assisted peroneal artery perforator flap in repairing oral and maxillofacial defects. Methods The clinical data of 20 patients with oral and maxillofacial malignant tumors treated with peroneal artery perforator flap between October 2020 and December 2021 were retrospectively analysed. There were 13 males and 7 females, with an average age of 56.5 years (range, 32-76 years). There were 8 cases of tongue cancer, 5 cases of parotid gland cancer, 4 cases of buccal cancer, and 3 cases of mandibular gingival cancer; and 12 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, and 5 cases of mucoepidermoid carcinoma. Color Doppler ultrasound (CDU) and IRT technique were performed before operation to locate the peroneal artery perforator and assist in the design of the flap. The sensitivity, specificity, positive predictive value, and negative predictive value of CDU and IRT technique were compared with the actual exploration during operation. The accuracy of CDU and IRT technique in detecting the number of peroneal artery perforator and the most viable perforating points was compared. The patients were followed up regularly to observe the recovery of donor and recipient sites, the occurrence of complications, and the recurrence and metastasis of tumors. Results The sensitivity, specificity, positive predictive value, and negative predictive value of peroneal artery perforators detected by IRT technique before operation were 72.22%, 50.00%, 92.86%, and 16.67% respectively, which were higher than those by CDU (64.17%, 33.33%, 84.62%, and 14.29% respectively). Forty-five peroneal artery perforators were found by CDU before operation, and 35 were confirmed during operation, with an accuracy rate of 77.8%; 43 "hot spots" were found by IRT technique, and 32 peroneal artery perforators were confirmed within the "hot spots" range during operation, with an accuracy rate of 74.4%; there was no significant difference between the two methods ( χ²=0.096, P=0.757). The accuracy rates of the most viable perforating points found by CDU and IRT technique were 80.95% (17/21) and 94.74% (18/19), respectively, and there was no significant difference between them ( χ²=0.115, P=0.734). The localization errors of CDU and IRT technique were (5.12±2.10) and (4.23±1.87) mm, respectively, and there was no significant difference between them ( t=1.416, P=0.165). All the perforator flaps survived, and the incisions of donor and recipient sites healed by first intention. All patients were followed up 5-18 months, with an average of 11 months. The skin flap was soft and had good blood supply, and the lower limb scar was concealed and the lower limb had good function. No lower limb swelling, pain, numbness, ankle instability, or other complications occurred, and no tumor recurrence and metastasis were found during the follow-up. Conclusion Compared with the CDU, using the IRT technique to assist the preoperative peroneal artery perforator flap design to repair the oral and maxillofacial defects has a high clinical application value.
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Affiliation(s)
- 蕴 郭
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 文静 崔
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 开洋 宗
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 建成 李
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 悦 孙
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 恺 胡
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 默 陈
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
| | - 如毅 江
- 蚌埠医学院第一附属医院口腔颌面外科(安徽蚌埠 233004)Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China
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Nischwitz SP, Luze H, Schellnegger M, Gatterer SJ, Tuca AC, Winter R, Kamolz LP. Thermal, Hyperspectral, and Laser Doppler Imaging: Non-Invasive Tools for Detection of The Deep Inferior Epigastric Artery Perforators-A Prospective Comparison Study. J Pers Med 2021; 11:jpm11101005. [PMID: 34683146 PMCID: PMC8538291 DOI: 10.3390/jpm11101005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Perforator flaps have become one of the leading procedures in microsurgical tissue transfer. Individual defects require a tailored approach to guarantee the most effective treatment. A thorough understanding of the individual vascular anatomy and the location of prominent perforators is of utmost importance and usually requires invasive angiography or at least acoustic Doppler exploration. In this study, we aimed at evaluating different non-invasive imaging modalities as possible alternatives for perforator location detection. After a cooling phase, we performed thermal, hyperspectral and Laser Doppler imaging and visually evaluated a possible detection of the perforator for a period of five minutes with an image taken every minute. We identified the most prominent perforator of the deep inferior epigastric artery by handheld acoustic Doppler in 18 patients. The detected perforator locations were then correlated. Eighteen participants were assessed with six images each per imaging method. We could show a positive match for 94.44%, 38.89%, and 0% of patients and 92.59%, 25.93%, and 0% of images for the methods respectively compared to the handheld acoustic Doppler. Sex, age, abdominal girth, and BMI showed no correlation with a possible visual detection of the perforator in the images. Therefore, thermal imaging can yield valuable supporting data in the individualized procedure planning. Future larger cohort studies are required to better assess the full potential of modern handheld thermal imaging devices.
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Affiliation(s)
- Sebastian P. Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (H.L.); (A.-C.T.); (R.W.); (L.-P.K.)
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria;
- Correspondence:
| | - Hanna Luze
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (H.L.); (A.-C.T.); (R.W.); (L.-P.K.)
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria;
| | - Marlies Schellnegger
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria;
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, 8036 Graz, Austria
| | | | - Alexandru-Cristian Tuca
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (H.L.); (A.-C.T.); (R.W.); (L.-P.K.)
| | - Raimund Winter
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (H.L.); (A.-C.T.); (R.W.); (L.-P.K.)
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (H.L.); (A.-C.T.); (R.W.); (L.-P.K.)
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria;
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Pan JD, Xu H, Xiao DC, Hacquebord JH, Chang SM, Wang X. Perforator Detection by Thermographic Imaging Augmented With Tourniquet-Reperfusion: A Modified Approach and Preliminary Report in Distal Lower Leg Reconstruction. Ann Plast Surg 2021; 87:451-456. [PMID: 33587459 DOI: 10.1097/sap.0000000000002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dynamic infrared thermography provides a new imaging method of perforator detection. This study introduces an augmented technique to improve its accuracy by tourniquet-reperfusion and reports its preliminary use in the distal lower leg reconstruction. METHODS A tourniquet (450 mm Hg) was applied for 3 minutes on proximal thighs. After the tourniquet release, the rewarming rate and pattern of hotspots were observed by thermography to delineate the location and quality of perforators. The results were compared with those detected by computed tomographic angiography. Clinically, the local transferred posterior tibial artery or peroneal artery propeller perforator flap was performed in 9 patients for the distal lower leg reconstruction. RESULTS There was a 20- to 140-second "perforator observing window" after the tourniquet release. Tourniquet-reperfusion augmented thermal imaging method (TRATIM) had a sensitivity of 90.3% and a positive predictive value of 93.3%. The TRATIM and computed tomographic angiography had an excellent concordance with a kappa index value of 0.839 (P < 0.001). Based on the TRATIM, 9 propeller perforator flaps were successfully designed and raised for the distal lower leg resurfacing. All flaps survived entirely, except one with size of 1.0 cm × 2.0 cm that had terminal necrosis. CONCLUSIONS The TRATIM is a quick, easy, cheap, and reliable approach for perforator detection in the lower leg. With the aid of TRATIM, a customized propeller perforator flap could be raised efficiently for the distal lower leg reconstruction.
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Affiliation(s)
| | - Heng Xu
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Chao Xiao
- Department of Hand Surgery, Ningbo Sixth Hospital, Ningbo
| | - Jacques Henri Hacquebord
- Department of Orthopedic Surgery, Hansjörg Wyss Department of Plastic Surgery, New York University, New York, USA
| | - Shi-Min Chang
- From the Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai
| | - Xin Wang
- Department of Hand Surgery, Ningbo Sixth Hospital, Ningbo
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Goetze E, Thiem DGE, Gielisch MW, Kämmerer PW. Identification of cutaneous perforators for microvascular surgery using hyperspectral technique - A feasibility study on the antero-lateral thigh. J Craniomaxillofac Surg 2020; 48:1066-1073. [PMID: 32994154 DOI: 10.1016/j.jcms.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/11/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
Aim of the study was to compare perforator vessel location using color-coded Doppler ultrasound and hyperspectral imaging in the area of the antero-lateral thigh. In a cross-sectional case-control study, the bilateral antero-lateral thigh region was examined for perforator vessel location via color-coded Doppler ultrasound (control) and hyperspectral imaging (test). For hyperspectral imaging, all measurements were conducted without cooling (T0) and after 1 (T1), 2 (T2) and 3 min (T3) of cooling. Additionally, in the reperfusion period after cooling, hyperspectral imaging was conducted at 1, 2 and 3 min (T4/T5/T6). Results from color-coded Doppler ultrasound and hyperspectral imaging were matched at all time points (T0-T6). In total, 71/73 perforator vessel locations could be matched (sensitivity: 97%). Matching of color-coded Doppler ultrasound and hyperspectral imaging was significantly influenced by the cooling protocol and the highest matching values were seen at T3 (3 min cooling; 60 perforator vessels) and T4 (3 min cooling & 1 min reperfusion; 62 perforator vessels) without significant differences (sensitivity 98%; p = 0.9). There were significant differences between T4 and T0, T1 (both p < 0.001), T5 (p = 0.045) and T6 (p = 0.012). For clinical proof of concept, a patient case using a free antero-lateral thigh flap for reconstruction of a facial defect after perforator vessel identification via color-coded Doppler ultrasound and hyperspectral imaging (3 min cooling & 1 min reperfusion) was carried out successfully. In conclusion, hyperspectral imaging potentially offers an additional opportunity for non-invasive, user-independent perforator-site assessment if prior cooling of the site is conducted.
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Affiliation(s)
- Elisabeth Goetze
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054, Erlangen, Germany; Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054, Erlangen, Germany
| | - Matthias W Gielisch
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054, Erlangen, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glueckstrasse 11, 91054, Erlangen, Germany.
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