Perfusion dynamics of 16 free DIEP flaps and 4 free SIEA flaps were studied during the first, third, and sixth postoperative day using dynamic infrared thermography (DIRT). For both flap types the zone positioned over the perforator is perfused first, followed by the adjacent ipsilateral zone, and finally the contralateral zones. Perfusion of the subdermal plexus of all zones preceded the perfusion of the subcutaneous layer of all zones. While the initial hyperemia subsided with time, the total number of hot spots increased with time. Perfusion of free DIEP and SIEA flaps during the first postoperative week is a dynamic process. The perfusion shows a stepwise progression at the level of the subdermal plexus and at the level of the subcutaneous layer each with its own time sequence and with the midline as an area of resistance for circulation.

The purpose of the study was to examine the effect of a 12 h period of abstinence from smoking in young and old habitual smokers, on skin rewarming patterns of a hand following local cooling. This was done by comparing changes in peripheral circulation, measured indirectly by monitoring changes in skin surface temperatures of the hand with both infrared (IR) thermography and thermocouples before, during and after immersing the right hand for 2 min in water at 10 degrees C. Included in the study were young male non-smokers (n = 14) and smokers (n = 13), and elderly non-smokers (n = 12) and smokers (n = 14). The results showed no statistically significant difference between young non-smokers and smokers when comparing their response to the local cold challenge. The elderly smokers had a significantly higher hand skin temperature prior to cooling (34.0 +/- 0.2 degrees C) and after 80% rewarming (32.1 +/- 0.2 degrees C) (i.e. when the skin temperature in the "cooled" hand has regained 80% of the cold induced drop in temperature), compared to elderly non-smokers (33.3 +/- 0.2 and 31.3 +/- 0.2 degrees C, respectively). The elderly smoking subjects also had a faster recovery after cooling (9.7 +/- 0.8 min) than the elderly non-smoking subjects (16.7 +/- 2.6 min). A follow-up study with seven elderly smokers, who had smoked as usual until 2 h before the experiment, showed responses lying between the non-smokers and smokers who had had a longer period of abstinence (12 h) from smoking. In conclusion, we have demonstrated using IR-thermal imaging that elderly subjects who have smoked for many years have slightly warmer hand skin temperature when they abstain from smoking. Even a period of abstinence from smoking of a few hours can affect the way in which elderly subjects respond to a local cold challenge, recovering more rapidly then their non-smoking counterparts.

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