Chava Sravan Kumar, Agrawal Mansi, Vidya Konduru, Janakiraman Rajinikanth, Palaniyandi Kuppan, Ramachandran Oyyaravelu, Tirkey Amit Jiwan
From the Department of Head and Neck Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Banjara Hills, Hyderabad, Telangana, India.
Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India.
Plast Reconstr Surg Glob Open. 2023 Sep 29;11(9):e5158. doi: 10.1097/GOX.0000000000005158. eCollection 2023 Sep.
Reconstruction using microvascular free flaps has become the standard of care in head and neck cancer surgery, and their success lies in appropriate planning, adequate revascularization, and early detection of flap compromise so that prompt salvage is possible. This study evaluates the role of infrared thermography in the planning, execution, and postoperative monitoring of microvascular flaps in head and neck reconstructions.
This is a single institutional, prospective observational study conducted at a tertiary care hospital in South India for 13 months. Twenty patients were included, and their thermographic images were captured in the preoperative, intraoperative, and postoperative settings using the infrared camera FLIR T400. These images were analyzed along with the Doppler, and clinical monitoring findings in all the settings and the temperature difference were calculated postoperatively.
Hotspot perforator marking was made using infrared camera, and perforator marking was made using hand-held Doppler preoperatively, which correlated in 93% of cases. Intraoperatively, flap rewarming was successfully demonstrated in 19 of 20 cases. Postoperatively, flap compromise was observed on infrared thermography during the first 24 hours but not on clinical monitoring in three cases. The temperature difference values recorded were 5.4°C, 2.4°C, and 4.9°C. The mean of temperature difference of the healthy flaps was 1.0°C (range 0.1°C-1.8°C).
Infrared thermography provides simple and reliable imaging, which can be used in perforator marking and flap designing preoperatively and checking the flap perfusion and vascular anastomosis patency intra- and postoperatively.
使用游离微血管皮瓣进行重建已成为头颈癌手术的标准治疗方法，其成功取决于适当的规划、充分的血管再通以及早期发现皮瓣受损情况，以便能够及时进行挽救。本研究评估了红外热成像在头颈重建中微血管皮瓣的规划、实施和术后监测中的作用。
这是一项在印度南部一家三级护理医院进行的为期13个月的单机构前瞻性观察研究。纳入了20名患者，并使用红外热像仪FLIR T400在术前、术中和术后采集了他们的热成像图像。将这些图像与多普勒检查结果一起进行分析，并计算所有情况下的温差以及术后的温差。
术前使用红外热像仪进行热点穿支标记，同时使用手持式多普勒进行穿支标记，二者在93%的病例中具有相关性。术中，20例中有19例成功显示皮瓣复温。术后，在最初24小时内通过红外热成像观察到3例皮瓣受损，但临床监测未发现。记录的温差值分别为5.4°C、2.4°C和4.9°C。健康皮瓣的平均温差为1.0°C（范围0.1°C - 1.8°C）。
红外热成像提供了简单可靠的成像，可用于术前穿支标记和皮瓣设计，以及术中和术后检查皮瓣灌注和血管吻合通畅情况。
