Afzal Muhammad Omar, Haq Ata Ul, Riaz Muhammad Ahsan, Tarar Moazzam Nazeer, Alvi Hamid Fazeel
ALLAMA Iqbal medical college/ Jinnah burn and reconstructive surgery centre Lahore.
Allama Iqbal Medical College/ Jinnah Burn and Reconstructive Surgery Centre Lahore.
J Ayub Med Coll Abbottabad. 2020 Oct-Dec;32(Suppl 1)(4):S612-S617.
Presence of good size perforators are mandatory to design perforator based pedicelledflaps specially in lower limb as flap failure rate isrelativelyhigh. We have explored the use ofsmartphonebaseddynamic thermal imagingand compared it with doppler to devise a protocol forplanning and executionof pedicled perforator flaps anddescribedits use in deciding delay of flap. We have also compared the time required for detecting dominant perforators.
This prospective case series was done atJinnah burn and reconstructive surgery center Lahore from July to September 2018and included patients requiring pedicled fasciocutaneous or musculocutaneous flapfor lower extremity reconstruction. Smartphonebased dynamic thermal imaging and doppler wereused to map out suitable perforators and confirmed intraoperatively. Comparison was made regarding their ability to locatedominant perforatorsandtotal time required.Utility of thermal imaging to ascertain flap perfusion postoperatively was also assessed.Flaps were designed according to thermal mapping. Clinical judgement supplemented with thermal imaging was usedto ascertain flap survival.
The study included 15 patientsin which22 out 23 dominant perforators as located withthermal imaging were confirmed intra-operatively (positive predictive value = 95.7%) as compared to 22 out of 32 with doppler(positive predictive value=68.8%). Mean time required with doppler was 591.27±252.48, compared to 598.47±192.94 seconds with thermal imaging. In two cases flap was delayed. Partial flap necrosis occurred in one case.
Dynamic thermal imaging can be reliably usedin planning of pedicled perforator flaps for lower limb reconstruction. We have found itmore reliable than handhelddoppler in locating dominant perforators.
设计带蒂穿支皮瓣时，必须有足够大小的穿支，尤其是在下肢，因为皮瓣失败率相对较高。我们探索了基于智能手机的动态热成像技术，并将其与多普勒技术进行比较，以制定带蒂穿支皮瓣的规划和实施方案，并描述其在确定皮瓣延迟方面的应用。我们还比较了检测主要穿支所需的时间。
本前瞻性病例系列研究于2018年7月至9月在拉合尔真纳烧伤与重建外科中心进行，纳入需要带蒂筋膜皮瓣或肌皮瓣进行下肢重建的患者。使用基于智能手机的动态热成像和多普勒技术来确定合适的穿支，并在术中进行确认。比较它们定位主要穿支的能力和所需的总时间。还评估了热成像在术后确定皮瓣灌注情况的实用性。根据热成像图设计皮瓣。临床判断辅以热成像来确定皮瓣存活情况。
该研究纳入了15例患者，其中热成像定位的23个主要穿支中有22个在术中得到确认（阳性预测值 = 95.7%），而多普勒定位的32个中有22个得到确认（阳性预测值 = 68.8%）。多普勒所需的平均时间为591.27±252.48秒，而热成像为598.47±192.94秒。有2例皮瓣进行了延迟处理。1例发生了部分皮瓣坏死。
动态热成像可可靠地用于下肢重建带蒂穿支皮瓣的规划。我们发现它在定位主要穿支方面比手持多普勒更可靠。
