Performance of infrared thermography and thermal stress test in perforator mapping and flap monitoring: A meta-analysis of diagnostic accuracy

Raheman, Firas; Rojoa, Djamila; Patel, Nakul

doi:10.1016/j.bjps.2021.03.088

Cited by 8 publications

(12 citation statements)

References 33 publications

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“…17,23,28 The sensitivities lie between 89.6 and 99.6% and specificities between 96 and 99.9%. 20 After supplying blood to the chest wall, IMA continues to the abdomen wall as the superior epigastric artery, where it anastomosises itself to the inferior epigastric artery to supply the perfusion to the abdominal wall. In breast reconstruction using abdominal flaps, the inferior epigastric artery is elevated together with the fasciocutaneous tissues and the vessel anastomosis is usually performed to the IMA and vein.…”

Section: Discussionmentioning

confidence: 99%

“…17 , 23 , 28 The sensitivities lie between 89.6 and 99.6% and specificities between 96 and 99.9%. 20 …”

Section: Discussionmentioning

confidence: 99%

“…The measurement of thermal radiation has been proven so far to have useful applications in different domains like monitoring the heart rate and respiratory rates in experimental pigs, 2 brain mapping, 7 , 10 , 16 tumor detection, 22 identifying the perforator vessels for flap surgery 26 , 9 as well as for determining the skin perfusion postoperatively after flap harvest. 20 Infrared thermography (IRT) implies a non-invasive, accessible and label-free technique. In patients undergoing CABG surgery, high resolution thermography of the chest wall may be valuable for identifying changes in perfusion, especially in patients at risk.…”

Section: Introductionmentioning

confidence: 99%

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Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

et al. 2022

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Coronary artery disease represents a leading cause of death worldwide, to which the coronary artery bypass graft (CABG) is the main method of treatment in advanced multiple vessel disease. The use of the internal mammary artery (IMA) as a graft insures an improved long-term survival, but impairment of chest wall perfusion often leads to surgical site infection and increased morbidity and mortality. Infrared thermography (IRT) has established itself in the past decades as a non-invasive diagnostic technique. The applications vary from veterinary to human medicine and from head to toe. In this study we used IRT in 42 patients receiving CABG to determine the changes in skin surface temperature preoperatively, two hours, 24 h and 6 days after surgery. The results showed a significant and independent drop of surface temperature 2 h after surgery on the whole surface of the chest wall, as well as a further reduction on the left side after harvesting the IMA. The temperature returned to normal after 24 h and remained so after 6 days. The study has shown that IRT is sufficiently sensitive to demonstrate the known, subtle reduction in chest wall perfusion associated with IMA harvesting.

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Section: Discussionmentioning

confidence: 99%

“…17 , 23 , 28 The sensitivities lie between 89.6 and 99.6% and specificities between 96 and 99.9%. 20 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

et al. 2022

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“…27 IRT was used to assess the perfusion change by detecting the temperature change in the flap and a series of studies have confirmed its usefulness in perfusion evaluation. 28 29 30 31 Other technologies such as ICG angiography or laser Doppler flowmetry can also be used to estimate the change in flap perfusion, 32 33 while the venous injection of ICG was required. In this study, we applied ICG angiography for the initial 4 patients to confirm the occlusion effect of the cable tie at the starting stage.…”

Section: Discussionmentioning

confidence: 99%

An Innovative and Economical Device for Ischemic Preconditioning of the Forehead Flap Prior to Pedicle Division: A Comparative Study

Xiao

et al. 2022

J Reconstr Microsurg

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Background Ischemic preconditioning of the forehead flap prior to pedicle division helps to improve angiogenesis. Clamping the pedicle by a clamped rubber band with vessel forceps is often clinically applied. However, the severe pain and unstable blocking effect influenced the preconditioning process. In this study, we described an innovative device designed for ischemic preconditioning and compared its efficacy with the clamped rubber band. Methods The device consists of a self-locking nylon cable tie with a buckle and a rubber tube. The rubber tube is fed over the cable tie to act as a soft outer lining and the cable tie is tightened across the pedicle to block the perfusion for ischemic preconditioning. This device and the standard clamped rubber band were applied respectively before division surgery. The constriction effect, reliability, reproducibility, and the patients' pain tolerance were compared. Results A total of 20 forehead flaps were included. The cable tie had less incidence of loosening (7.7% vs. 16.6%, p < 0.05) and maintained the pressure more effectively. The pain score for the nylon cable tie was significantly lower than the clamped rubber band (4.25 ± 1.02 vs. 6.75 ± 1.12, p < 0.05), especially for 10 pediatric patients (4.50 ± 0.85 vs. 8.10 ± 1.20, p < 0.01). All 20 pedicles were successfully divided at 19 to 22 days with no surgical complications. Conclusion Compared with the clamped rubber band, the cable tie produces a more reliable and reproducible ischemic preconditioning effect. It is also better tolerated by the patients. Therefore, we recommend using the nylon cable tie as the preferred device for ischemic preconditioning of the forehead flap.

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“…Infrared thermography (IRT) monitors the temperature by detecting the infrared radiation emitted from tissue. Recently, it has gained popularity in plastic surgery, such as detecting the perforator preoperatively or evaluating the flap perfusion intra-and postoperatively [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

The Use of Infrared Thermography in Determining Timing for Early Pedicle Division of the Preexpanded Bipedicled Visor Flap after Ischemic Preconditioning

Xiao

Zhang

et al. 2022

Applied Bionics and Biomechanics

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Background. The preexpanded bipedicled visor flap, supported by the bilateral superficial temporal vessels, stands as an ideal choice for upper and lower lip reconstruction in males. However, the bilateral tissue bridges after flap transfer caused patients significant cosmetic deformity and psychological burden. Early division of bilateral pedicles reduced the length of hospitalization and expenses. In this study, infrared thermography (IRT) was used to guide the early pedicle division after ischemic preconditioning. Methods. This study retrospectively analyzed patients who underwent preexpanded bipedicled visor flap surgery from April 2018 to October 2021. Pedicle division was scheduled at two weeks postflap transfer. Ischemic preconditioning was initiated 3-5 days in advance by repeatedly clamping both pedicles. The temperature alteration of the flap and the temperature difference compared to the normal adjacent tissue were evaluated by IRT. The division surgery was not scheduled until the perfusion assessment indicated adequate. This comprised of subjective examination and indocyanine green angiography. The threshold of temperature difference to determine the pedicle division was analyzed based on the temperature changes between the clamps. Results. A total of 8 male patients successfully conducted the pedicle division without any complications. The delay period after ischemic preconditioning ranged from 14 to 19 days (average 16 days). Through ischemic preconditioning training, the average temperature of the flap gradually increased from 31.85 ± 0.36 °C to 33.89 ± 0.50 °C, and the temperature difference with the normal surrounding tissues decreased from 2.89 ± 0.30 °C to 1.15 ± 0 . 46 ° C (95% confidence interval (1.5, 0.8)). The temperature difference stayed unchanged after pedicle division. Conclusion. Ischemic preconditioning shortens the perioperative period to pedicle division. Monitoring the temperature change reflects the revascularization between the flap and the recipient site, thus guiding the pedicle division. The temperature difference less than 1.5°C after clamping both pedicles can be set as the safe threshold for pedicle division.

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Performance of infrared thermography and thermal stress test in perforator mapping and flap monitoring: A meta-analysis of diagnostic accuracy

Cited by 8 publications

References 33 publications

Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

An Innovative and Economical Device for Ischemic Preconditioning of the Forehead Flap Prior to Pedicle Division: A Comparative Study

The Use of Infrared Thermography in Determining Timing for Early Pedicle Division of the Preexpanded Bipedicled Visor Flap after Ischemic Preconditioning

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