Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, United States of America.
Pennsylvania State Health Milton S Hershey Medical Center, Dept Otolaryngology, Director, Facial Plastic & Reconstructive Surgery, United States of America.
Am J Otolaryngol. 2021 Mar-Apr;42(2):102751. doi: 10.1016/j.amjoto.2020.102751. Epub 2020 Oct 17.
Preoperative planning, design, and perioperative monitoring of microsurgical free flaps is of paramount importance to successful reconstruction. Infrared Thermography provides an indirect method by which vascular perfusion may be monitored and has previously shown efficacy in detection of cutaneous perforators. In a proof-of-concept study, we assessed the utility of infrared thermography in delineating angiosomes and monitoring for adequate tissue perfusion in the preoperative, intraoperative, and postoperative setting. This technology was compared to conventional indocyanine green fluorescence angiography (ICG-FA).
Four patients undergoing locoregional pedicled or free flap reconstruction were assessed using ICG-FA and Forward-looking infrared (FLIR) thermography in standardized conditions. Monitoring of flap angiosomes and tissue perfusion using both fluorescent pixel intensity and thermography was then performed implementing proprietary software.
Our study is unique in that tissue perfusion intraoperatively was assessed with both thermography and indocyanine green fluorescence angiography (ICG-FA), which represents a previously established system. We demonstrate that smartphone compatible thermal cameras may be used as an adjunct to clinical exam, as well as other monitoring technologies, providing further information in not only selection of perforators, in the operative setting, but also in the early detection of poor flap viability secondary to microvascular compromise allowing for timely salvage.
显微游离皮瓣的术前规划、设计和围手术期监测对于成功重建至关重要。红外热像技术提供了一种间接监测血管灌注的方法，先前已显示出在检测皮肤穿支方面的有效性。在一项概念验证研究中，我们评估了红外热像技术在术前、术中、术后划定血管分布区和监测组织灌注充足性方面的效用。该技术与传统的吲哚菁绿荧光血管造影（ICG-FA）进行了比较。
对 4 名接受局部带蒂或游离皮瓣重建的患者在标准化条件下进行 ICG-FA 和前视红外（FLIR）热成像评估。然后使用专有的软件实施荧光像素强度和热成像来监测皮瓣血管分布区和组织灌注。
我们的研究是独特的，因为术中组织灌注既可以用热成像也可以用吲哚菁绿荧光血管造影（ICG-FA）来评估，这代表了一种先前建立的系统。我们证明，智能手机兼容的热像仪可作为临床检查以及其他监测技术的辅助手段，不仅可以在手术环境中选择穿支，还可以在早期发现由于微血管阻塞导致的皮瓣活力不佳，从而及时进行挽救。
