Xiao Wentian, Li Ke, Kiu-Huen Ng Sally, Feng Shaoqing, Zhou Huihong, Nicoli Fabio, Blondeel Phillip, Zhang Yixin
From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Plastic Surgery, The Austin Hospital, Melbourne, Australia.
Ann Plast Surg. 2020 May;84(5S Suppl 3):S190-S195. doi: 10.1097/SAP.0000000000002369.
Preoperative localization of the perforators allows precise planning of the flap design and improves surgical efficiency. Recently, infrared thermography is introduced as a reliable alternative, where the perforator corresponds to the "hot spot" on the thermogram. This study aims to compare the application of color Doppler ultrasound (CDU) and infrared thermography in preoperative perforator mapping of the anterolateral thigh (ALT) perforator flap.
From September 2017 to January 2019, CDU and infrared thermography were both applied on 20 patients to locate the perforators originated from lateral circumflex femoral artery preoperatively. The perforators identified using each modality were marked on the anterolateral thigh region. The accuracy of both mapping methods was analyzed according to the intraoperative findings. The relation between location bias and the thickness of subcutaneous tissue was analyzed.
A total of 20 ALT flaps were included. Fifty-three perforators were detected by CDU, and 51 "hot spots" were identified by infrared thermography, in which 50 "hot spots" corresponded to CDU, and the consistency test showed that the κ index was 0.712 (P < 0.05), representing high consistency. The infrared thermography has a sensitivity of 94.3% and a specificity of 85.7% compared with CDU. The deviation between thermal imaging and CDU was positively correlated with the thickness of the subcutaneous tissue. The Pearson correlation coefficient was 0.84 (R = 0.84). Forty-four perforators marked by CDU were selected for designing the flap. Anatomical findings showed that the accuracy rate of CDU and infrared thermal was 93.2% (41 of 44) and 86.3% (38 of 44), respectively. There was no statistical difference (P > 0.05).
Compared with CDU, infrared thermography can be used to locate perforators, in this case, the ALT perforators, with a high degree of consistency. It is portable, economical, noninvasive, and easy to operate. It has higher accuracy in patients with thinner subcutaneous tissue. We believe that infrared thermography can be a useful technique for perforator mapping, especially in patients where the subcutaneous tissue is thinner.
术前对穿支血管进行定位有助于精确规划皮瓣设计并提高手术效率。近来，红外热成像技术作为一种可靠的替代方法被引入，其中穿支血管对应于热像图上的“热点”。本研究旨在比较彩色多普勒超声（CDU）和红外热成像技术在术前股前外侧（ALT）穿支皮瓣穿支血管定位中的应用。
2017年9月至2019年1月，对20例患者同时应用CDU和红外热成像技术术前定位发自旋股外侧动脉的穿支血管。将每种方法所确定的穿支血管标记在股前外侧区域。根据术中所见分析两种定位方法的准确性。分析定位偏差与皮下组织厚度之间的关系。
共纳入20个ALT皮瓣。CDU检测到53条穿支血管，红外热成像技术识别出51个“热点”，其中50个“热点”与CDU结果相符，一致性检验显示κ指数为0.712（P<0.05），表示高度一致。与CDU相比，红外热成像技术的敏感性为94.3%，特异性为85.7%。热成像与CDU之间的偏差与皮下组织厚度呈正相关。Pearson相关系数为0.84（R=0.84）。选择CDU标记的44条穿支血管用于设计皮瓣。解剖结果显示，CDU和红外热成像技术的准确率分别为93.2%（44条中的41条）和86.3%（44条中的38条）。无统计学差异（P>0.05）。
与CDU相比，红外热成像技术可用于定位穿支血管，在本研究中即ALT穿支血管，一致性较高。它便携、经济、无创且操作简便。在皮下组织较薄的患者中具有更高的准确性。我们认为红外热成像技术可成为一种有用的穿支血管定位技术，尤其是在皮下组织较薄的患者中。
