Infrared surface temperature monitoring in the postoperative management of free tissue transfers

Papillion, Paul; Wong, Lesley; Waldrop, Jimmy; Sargent, Larry A.; Brzezienski, Mark A.

doi:10.4172/plastic-surgery.1000606

Cited by 7 publications

(7 citation statements)

References 2 publications

(2 reference statements)

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“…22 Chiu et al and Kraemer et al suggested that a temperature difference between the flap and the surrounding normal tissue occurs early after free DIEP, and when the flap temperature falls rapidly by more than 3 C, it indicates arterial embolism. 17,18 Papillion et al used IRT to monitor flap temperature and retrospectively analysed the results of 47 free flaps and found that the flap temperature in failed cases decreased by 2 C within 8 h. 23 In conclusion, there is no universally accepted standard for determining the temperature difference of impaired flap supply, and previous studies have mostly monitored free flaps, with insufficient research on other flap types, and more relevant animal experiments may be needed to explore the relationship between temperature difference and flap necrosis in different flap types. 12 Vascular crisis as the most serious and common complication after flap repair is a serious threat to flap survival, early detection and recognition are essential to save the flap from necrosis.…”

Section: Discussionmentioning

confidence: 99%

A wireless infrared thermometry device for postoperative flap monitoring: Proof of concept in a porcine flap model

Xie

Liu

Zhang

et al. 2022

International Wound Journal

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The application of flap surgery is becoming more and more widespread with the development of microsurgical techniques. Currently, postoperative blood flow monitoring of flaps is still mainly assessed by medical staff for traditional clinical parameters, which has the disadvantage of being subjective and unable to monitor in real-time. This study describes a self-contained infrared wireless infrared thermometry device for flap blood supply monitoring and evaluates its effectiveness on eight porcine flap models. A scapular muscle flap model was established using eight small pigs, and the vessels were ligated at irregular intervals using a lumir ligature to simulate arterial crisis and venous crisis. Laser Doppler flowmetry (LDF), the wireless infrared thermometry device, and traditional clinical observation methods were applied to monitor the blood supply of the flap and evaluate the effect. The time to the determination of blood supply disturbance by wireless infrared thermography (IRT) was 28.75 ± 3.30 min and 96.5 ± 27.09 min for the arterial and venous groups, respectively; by LDF was 6.00 ± 1.41 min and 52.75 ± 15.76 min; by clinical observation was 42.00 ± 8.60 min and 156.50 ± 40.91 min, respectively. Paired t-tests were performed between the wireless IRT device and clinical observations, and the statistical results were significantly different in the arterial group and not significantly different in the venous group. Paired t-testing of the wireless infrared thermometry device with the LDF also showed significant differences in the arterial group and non-significant differences in the venous group. This wireless infrared thermometry device outperforms traditional clinical observation methods in monitoring blood supply in a porcine skin flap model. Because of its low cost, real-time monitoring, simple operation, and noninvasive features, it has the potential to be used in clinical practice as a routine means of postoperative blood supply monitoring in flap surgery.

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Section: Discussionmentioning

confidence: 99%

A wireless infrared thermometry device for postoperative flap monitoring: Proof of concept in a porcine flap model

Xie

Liu

Zhang

et al. 2022

International Wound Journal

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“…2). The temperature difference of up to 2°C was considered as acceptable 15 . Satisfactory perfusion was defined as adequate perfusion greater than 50% of the flap by both the methods.…”

Section: Methodsmentioning

confidence: 99%

Division of Fasciocutaneous Pedicled Flaps—Is It Time to Change Practice?

et al. 2022

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IntroductionThe study was carried out to evaluate the safety of early division of the pedicled flaps and to identify the optimum day of division.MethodsThis prospective, parallel arm, open-label, noninferiority, randomized controlled trial was carried out from January 2019 to July 2020. All patients (age, ≥5 years) undergoing reconstructive procedures using pedicled flaps were randomized in 1:1 ratio to receive either early division or conventional division protocol. In the early-division group, the flap perfusion, if satisfactory on day 8 by clinical and thermographic methods, a clamp was applied on the pedicle. The clamp was gradually tightened to produce controlled delay, and perfusion assessment was repeated after complete tightening. If satisfactory, the flaps were divided. Primary endpoints were flap at 24 hours after division, day of division, and day of complete inset of the flap. Secondary end points included perfusion of the flap on day 8, morbidity parameters (wound infection/suture dehiscence, need for secondary surgery and donor site morbidity), quality of life, and function scores.ResultsThirty-five patients were included in each group. The 2 groups were similar in terms of various demographic, clinicopathological variables, defect and flap characteristics. The flap survival rate was similar (P = 0.31) between the early (34/35) and standard (35/35) division groups. The early-division group had a significantly early mean day of flap division (mean difference of 12.74 days; P < 0.00001) and complete flap inset (mean difference of 12.09 days; P < 0.00001). All flaps had satisfactory perfusion on day 8. The wound infection rate was 1.33 times significantly higher in the conventional group (P = 0.033). There was a higher incidence of donor site morbidity (9% vs 0%) in the conventional group when compared with the early division group. The quality of life and function scores at 3 weeks (mean difference 2.37; P < 0.001) and 6 weeks (mean difference 3.76; P < 0.001) and adjacent joint stiffness were significantly higher in the early division group when compared with conventional group.ConclusionsThe pedicled flaps can be divided significantly early at an average duration of 10 to 11 days after flap inset with increased patient satisfaction rate and with a reduced postoperative morbidity. The authors have included a diversity of pedicled flaps used in different anatomic locations. By using stratified block randomization, we could ensure that the distribution was similar between the 2 groups, thus minimizing the heterogeneity in the analysis. This could also potentially indicate the usefulness of the controlled delay technique, irrespective of the anatomic location and type of the flap.

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“…10 Temperature monitoring is used to check flap circulation. 11,12 At the same time, appropriate warming care is needed to prevent vasospasm-induced compromised circulation. However, there is no consensus on whether warm protection affects flap temperature readings and interferes with temperature monitoring.…”

Section: Introductionmentioning

confidence: 99%

Standardized Skin Flap Warming Effectively Improves Flap Survival without Obstructing Temperature Monitoring after DIEP

Wang

Chu

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Objective: This study aimed to determine whether skin flap warming after an operation interferes with temperature monitoring. The postoperative nursing workflow of subabdominal deep inferior epigastric artery perforator (DIEP) flap breast reconstruction was optimized. Methods: A retrospective analysis involving 69 patients who received one-stage breast reconstruction at the Huashan Hospital from July 2017 to December 2019 was performed. The postoperative physical care of patients, including flap temperature monitoring and flap warming, was reviewed. Results: All patients had successful operations. After surgery, all flaps were warmed following the standard protocol. Abnormal temperature and compromised circulation of flaps were observed in three of the patients. These patients received re-exploration surgery and all three flaps survived. A postoperative follow-up shows a high level of patient satisfaction in most cases. Conclusions: The appropriate warming of transplanted flaps did not interfere with temperature monitoring. This helped determine whether there was compromised circulation, leading to increased skin flap survival and improved patient satisfaction.

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Infrared surface temperature monitoring in the postoperative management of free tissue transfers

Cited by 7 publications

References 2 publications

A wireless infrared thermometry device for postoperative flap monitoring: Proof of concept in a porcine flap model

A wireless infrared thermometry device for postoperative flap monitoring: Proof of concept in a porcine flap model

Division of Fasciocutaneous Pedicled Flaps—Is It Time to Change Practice?

Standardized Skin Flap Warming Effectively Improves Flap Survival without Obstructing Temperature Monitoring after DIEP

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