Early Detection of Flap Failure Using a New Thermographic Device

Tenorio, Xavier; Mahajan, Ajay L.; Wettstein, Reto; Harder, Yves; Pawlovski, M.; Pittet, Brigitte

doi:10.1016/j.jss.2008.03.001

Cited by 36 publications

(25 citation statements)

References 48 publications

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“…In particular: flap size and localization as well as body temperature, fever, respiratory flow and vascular circulation depending on the applied anaesthesia, angle between the tissue surface and the camera lens, room temperature and air humidity [16,17]. To eliminate these confounding factors the temperature difference between flap surface and regular surrounding tissue was measured instead of just measuring the absolute temperature of the flap's tissue surface [18]. In correlation to the endoscopic picture, a rectangle or elliptic measuring field was selected in the flap region (Area 1) as well as a second measuring field representing the surrounding, regular tissue (Area 2).…”

Section: Static Thermographymentioning

confidence: 99%

“…Vascular compromise or perfusion failure results in the need for revision surgery or in flap loss by exceeding the ischemic tolerance of the free flap in the postoperative course, eventually. However, permanent damage to the flap may already be present before clinical signs are apparent [18]. To date, intraoperative and postoperative monitoring of sufficient perfusion of free-flap reconstructions rely on the assessment of clinical signs by physical examination of the free flap: skin colour, tissue tension, capillary refill time and arterial pulse wave by manual palpation [5].…”

Section: Postoperative Flap Monitoring By Thermal Imagingmentioning

confidence: 99%

“…So far, no studies are available using IR thermography for free-flap monitoring in head and neck reconstructions. Thus, the usability of IR thermography to monitor perfusion in freeflap surgery was proven for breast reconstructions with the DIEP flap as well as for perforator selection and planning of flap design [4,18,22,27]. In comparison to other objective monitoring methods IR thermography has several advantages.…”

Section: Postoperative Flap Monitoring By Thermal Imagingmentioning

confidence: 99%

See 2 more Smart Citations

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Just

Chalopin

Unger

et al. 2015

Eur Arch Otorhinolaryngol

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The aim of this study is to investigate static and dynamic infrared (IR) thermography for intra- and postoperative free-flap monitoring following oropharyngeal reconstruction. Sixteen patients with oropharyngeal reconstruction by free radial forearm flap were included in this prospective, clinical study (05/2013-08/2014). Prior ("intraop_pre") and following ("intraop_post") completion of the microvascular anastomoses, IR thermography was performed for intraoperative flap monitoring. Further IR images were acquired one day ("postop_1") and 10 days ("postop_10") after surgery for postoperative flap monitoring. Of the 16, 15 transferred free radial forearm flaps did not show any perfusion failure. A significant decreasing mean temperature difference (∆T: temperature difference between the flap surface and the surrounding tissue in Kelvin) was measured at all investigation points in comparison with the temperature difference at "intraop_pre" (mean values on all patients: ∆T intraop_pre = -2.64 K; ∆T intraop_post = -1.22 K, p < 0.0015; ∆T postop_1 = -0.54 K, p < 0.0001; ∆T postop_10 = -0.58 K, p < 0.0001). Intraoperative dynamic IR thermography showed typical pattern of non-pathological rewarming due to re-established flap perfusion after completion of the microvascular anastomoses. Static and dynamic IR thermography is a promising, objective method for intraoperative and postoperative monitoring of free-flap reconstructions in head and neck surgery and to detect perfusion failure, before macroscopic changes in the tissue surface are obvious. A lack of significant decrease of the temperature difference compared to surrounding tissue following completion of microvascular anastomoses and an atypical rewarming following a thermal challenge are suggestive of flap perfusion failure.

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Section: Static Thermographymentioning

confidence: 99%

Section: Postoperative Flap Monitoring By Thermal Imagingmentioning

confidence: 99%

Section: Postoperative Flap Monitoring By Thermal Imagingmentioning

confidence: 99%

See 1 more Smart Citation

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Just

Chalopin

Unger

et al. 2015

Eur Arch Otorhinolaryngol

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“…This can be achieved by monitoring microcirculatory blood flow directly or flow-dependent variables, e.g., temperature, partial oxygen tension, oxygen saturation, pH, or oxidative energy metabolites before, during and after the operation. 5,[8][9][10][11] All of these methods have their pros and cons; the criteria that make them eligible in clinical practice include high reliability of the data, low invasiveness, as well as easy handling and acceptable costs.…”

Section: Introductionmentioning

confidence: 99%

Application of a new laser Doppler imaging system in planning and monitoring of surgical flaps

et al. 2010

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There is a demand for technologies able to assess the perfusion of surgical flaps quantitatively and reliably to avoid ischemic complications. The aim of this study is to test a new high-speed high-definition laser Doppler imaging (LDI) system (FluxEXPLORER, Microvascular Imaging, Lausanne, Switzerland) in terms of preoperative mapping of the vascular supply (perforator vessels) and postoperative flow monitoring. The FluxEXPLORER performs perfusion mapping of an area 9 x 9 cm with a resolution of 256 x 256 pixels within 6 s in high-definition imaging mode. The sensitivity and predictability to localize perforators is expressed by the coincidence of preoperatively assessed LDI high flow spots with intraoperatively verified perforators in nine patients. 18 free flaps are monitored before, during, and after total ischemia. 63% of all verified perforators correspond to a high flow spot, and 38% of all high flow spots correspond to a verified perforator (positive predictive value). All perfused flaps reveal a value of above 221 perfusion units (PUs), and all values obtained in the ischemic flaps are beneath 187 PU. In summary, we conclude that the present LDI system can serve as a reliable, fast, and easy-to-handle tool to detect ischemia in free flaps, whereas perforator vessels cannot be detected appropriately.

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“…In addition to the diagnosis of the AT, the thermographic device may be a promising monitoring tool of local-arterial thrombolysis. Early recognition of perfusion success is made intraoperatively [20]. Of the laboratory markers, D-dimer has shown clinical utility in the detection of early thromboembolism in human and dogs [3,13].…”

mentioning

confidence: 99%

Unilateral Femoral Arterial Thrombosis in a Dog with Malignant Mammary Gland Tumor: Clinical and Thermographic Findings, and Successful Treatment with Local Intra-arterial Administration of Streptokinase

Kim

Park

2012

The Journal of Veterinary Medical Science

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AbSTRAcT. An 8-year-old intact female dog presented with a sudden onset of unilateral hindlimb paralysis of 3 days duration. based on the history and results of physical, neurological, and histopathological examinations, and blood work, an arterial thrombosis was suspected as a complication of the hypercoagulability from a malignant mammary gland tumor. Thermography provided evidence of the unilateral femoral thrombus. Initially, thrombolysis with streptokinase administered by intravenous infusion was ineffective. Thereafter, the direct delivery of streptokinase to the site of thrombus was attempted. The approach was curative. These results suggest that thermography could describe the site of the arterial thrombus, and local intra-arterial administration of streptokinase may be an effective therapy for the canine arterial thrombosis complicated by malignant mammary gland tumor.

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Early Detection of Flap Failure Using a New Thermographic Device

Cited by 36 publications

References 48 publications

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences

Application of a new laser Doppler imaging system in planning and monitoring of surgical flaps

Unilateral Femoral Arterial Thrombosis in a Dog with Malignant Mammary Gland Tumor: Clinical and Thermographic Findings, and Successful Treatment with Local Intra-arterial Administration of Streptokinase

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