From the College of Medicine.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 4):S420-S425. doi: 10.1097/SAP.0000000000003343. Epub 2023 Feb 18.
Smartphone-based thermal imaging (SBTI) has been reported in the literature to be an easy-to-use, contactless, cost-friendly alternative to standard imaging modalities in identifying flap perforators, monitoring flap perfusion, and detecting flap failure. Our systematic review and meta-analysis aimed to evaluate SBTI's accuracy in perforator identification and secondarily evaluate SBTI's utility in flap perfusion monitoring as well as ability to predict flap compromise, failure, and survival.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was performed using PubMed from inception to 2021. Articles were uploaded into Covidence and, following duplicate deletion, were initially screened for use of SBTI in flap procedures through title and abstract screening followed by full-text review. The following data points, if provided, were extracted from each included study: study design, number of patients, patient demographics, perforator number and location, flap number and location, room temperature, cooling method, imaging distance, time from cloth removal, primary (SBTI's accuracy in perforator identification), and secondary outcomes (prediction of flap compromise/failure/survival and cost analysis). Meta-analysis was performed using RevMan v.5.
The initial search yielded 153 articles. Eleven applicable studies with a total of 430 flaps from 416 patients were ultimately included. The SBTI device assessed in all included studies was FLIR ONE. Four studies assessed the SBTI's perforated detection ability and were included in meta-analysis. Smartphone-based thermal imaging correctly identified 378 (93.3%; n = 405) perforators, and computed tomography angiography (CTA) correctly identified 402 (99.2%; n = 402), although in one study SBTI found additional perforators not detected on CTA. A random-effects model was used (I2 = 65%), and no significant difference in perforator detection ability was found between SBTI and CTA (P = 0.27).
This systematic review and meta-analysis supports SBTI as user- and cost-friendly ($229.99), contactless imaging modality with perforator detection ability comparable to current criterion-standard CTA. Postoperatively, SBTI outperformed Doppler ultrasound in early detection of microvascular changes causing flap compromise, allowing for prompt tissue salvage. With a minimal learning curve, SBTI seems to be a promising method of postoperative flap perfusion monitoring able to be used by all hospital ranks. Smartphone-based thermal imaging could thus increase flap monitoring frequency and lower complication rates, although further study is warranted.
智能手机热成像（SBTI）已在文献中报道，它是一种易于使用、非接触式、具有成本效益的替代标准成像方式，可以识别皮瓣穿支血管、监测皮瓣灌注以及检测皮瓣失败。我们的系统评价和荟萃分析旨在评估 SBTI 在穿支血管识别中的准确性，并次要评估 SBTI 在皮瓣灌注监测中的效用以及预测皮瓣失代偿、失败和存活的能力。
根据系统评价和荟萃分析的首选报告项目指南，我们使用 PubMed 进行了系统评价，检索时间从建库至 2021 年。将文章上传到 Covidence 后，通过标题和摘要筛选，首先筛选出用于皮瓣手术的 SBTI，然后进行全文审查。从每个纳入的研究中提取以下数据点（如果提供）：研究设计、患者数量、患者人口统计学、穿支血管数量和位置、皮瓣数量和位置、室温、冷却方法、成像距离、脱布后时间、主要（SBTI 在穿支血管识别中的准确性）和次要结果（皮瓣失代偿/失败/存活的预测和成本分析）。使用 RevMan v.5 进行荟萃分析。
最初的搜索产生了 153 篇文章。最终纳入了 11 项符合条件的研究，共涉及 416 例患者的 430 个皮瓣。所有纳入研究评估的智能手机热成像设备均为 FLIR ONE。四项研究评估了 SBTI 的穿孔检测能力，并纳入荟萃分析。智能手机热成像正确识别了 378 个（93.3%；n = 405）穿支血管，计算机断层血管造影（CTA）正确识别了 402 个（99.2%；n = 402），尽管在一项研究中，SBTI 发现了 CTA 未检测到的额外穿支血管。使用随机效应模型（I2 = 65%），SBTI 和 CTA 之间在穿支血管检测能力方面无显著差异（P = 0.27）。
这项系统评价和荟萃分析支持 SBTI 作为一种用户友好且具有成本效益的（229.99 美元）非接触式成像方式，其穿支血管检测能力可与当前标准的 CTA 相媲美。术后，SBTI 在早期检测导致皮瓣失代偿的微血管变化方面优于多普勒超声，从而能够及时进行组织挽救。SBTI 具有最小的学习曲线，似乎是一种有前途的术后皮瓣灌注监测方法，所有医院级别的人员都可以使用。因此，智能手机热成像可以增加皮瓣监测的频率并降低并发症的发生率，尽管还需要进一步研究。
