Thermal, Hyperspectral, and Laser Doppler Imaging: Non-Invasive Tools for Detection of The Deep Inferior Epigastric Artery Perforators—A Prospective Comparison Study

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.

Assessment of Mastectomy Skin Flaps for Immediate Reconstruction with Implants via Thermal Imaging—A Suitable, Personalized Approach?

“…Personalized thermal imaging may be of particular value in establishing individual treatment concepts. To date, thermal imaging via FLIR ONE has widely been clinically employed, for instance, in the individual assessment of burn wounds [ 13 , 17 , 18 , 19 ], diagnosis of complex regional pain syndrome [ 20 ], detection of perforator vessels in reconstructive surgery [ 14 , 21 , 22 ] and many other settings where thermal distribution patterns can yield proxy data. Within the field of breast oncology in particular, thermal imaging has recently been investigated as an emerging modality in breast-cancer screening [ 23 , 24 ] and has been considered a helpful tool in the treatment of breast-cancer-related lymphedema [ 25 ].…”

“…Within the field of breast oncology in particular, thermal imaging has recently been investigated as an emerging modality in breast-cancer screening [ 23 , 24 ] and has been considered a helpful tool in the treatment of breast-cancer-related lymphedema [ 25 ]. Apart from the low initial costs and ease of use of the FLIR ONE device, the non-invasive, no-touch character and absence of radiation are among the many advantages of this technique [ 22 , 23 ].…”

Neue Technologien in der Mikrochirurgie: Potential, Indikationen und ökonomische Aspekte – Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM)

“…So konnte bereits ein signifikanter Zusammenhang zwischen dem Durchmesser der superfiziellen inferioren epigastrischen Vene (SIEV), Perforatordurchmesser sowie deren Verhältnis zueinander und der Notwendigkeit eines venösen "Superchargings" der Lappenplastik gezeigt werden [28]. In einer prospektiven Vergleichsstudie von nicht-invasiven Alternativen zur präoperativen Doppler-Untersuchung konnte die thermale Bildgebung in 94 % der Patienten eine übereinstimmende Darstellung der Perforatoren im Vergleich zur Doppler-Untersuchung erreichen, während sich die Hyperspektral-und Laserdopplerbildgebungen als ungeeignet herausstellten [30]. Obwohl in vielen Kliniken die intraoperative Verwendung der Indocyaningrün (ICG)Angiografie mittlerweile zum Standard gehört, fehlen weiterhin prospektive Studien, , die die Wirksamkeit der Technik beschreibt was das Vermeiden Ischämie-bedingten Komplikationen angeht, wie zum Beispiel Wundheilungsstörung, Hautnekrose und Fettgewebsnekrose [31].…”

Evaluation of the Influence of Short Tourniquet Ischemia on Tissue Oxygen Saturation and Skin Temperature Using Two Portable Imaging Modalities

“…Near-infrared imaging (NIRI) and thermographic imaging were used to measure the changes in temperature and tissue oxygen saturation. These imaging modalities are already used in reconstructive plastic surgery and in the context of solid organ transplantation [ 9 , 10 , 11 , 12 ]. NIRI has been described in plastic surgery to monitor free flaps postoperatively by measuring tissue oxygen saturation [ 13 ].…”