Roukoz J, Bilger G, Chatard M, Hollard-Kissel F, Gédor M, Brix M, Simon E
Service de chirurgie maxillofaciale et plastique, CHU de Nancy, hôpital Central, 29, avenue du Maréchal-de-Lattre-de-Tassigny-CO60034, 54035 Nancy cedex, France.
Service de chirurgie maxillofaciale et plastique, CHU de Nancy, hôpital Central, 29, avenue du Maréchal-de-Lattre-de-Tassigny-CO60034, 54035 Nancy cedex, France.
Ann Chir Plast Esthet. 2025 Jan;70(1):10-18. doi: 10.1016/j.anplas.2024.09.002. Epub 2024 Oct 23.
The success of surgeries involving free flaps largely depends on accurate preoperative mapping of perforator arteries. Various imaging techniques, such as Doppler ultrasound and CT angiography, are typically used, each having its advantages and disadvantages in terms of cost, accuracy, and patient risk. The main objective of our study is to compare the effectiveness of the FLIR One device for detecting these arteries compared with traditional methods. Thermal imaging appears to be a simpler, less expensive, and less invasive alternative for surgical planning.
The study, conducted at the Regional Hospital Center of Nancy, included 25 free flaps (DIEP) on an exclusively female cohort of 22 patients, with follow-up from 2022 to 2023. Before the procedure, an abdominal-pelvic CT angiography was performed, followed by additional evaluation with thermal imaging using FLIR One and acoustic Doppler examination on the eve of the operation. This approach aimed to provide precise mapping of vascular perforators for each patient. Three different operators performed these markings, and the results were then compared with intraoperative observations. The imaging protocol also included a Doppler examination to validate the results of the thermal imaging. Statistical analyses with intraclass correlation coefficients (ICC) were performed to evaluate the correlation between different preoperative localization methods of perforating vessels.
In 22 patients undergoing 25 DIEP flaps for breast reconstructions, three imaging techniques were used to identify vascular perforators: thermal imaging with FLIR, acoustic Doppler, and CT angiography. FLIR identified the most perforators (n=137), followed by acoustic Doppler (n=128) and CT angiography (n=126). Comparing these with intraoperative results, 66% of perforators identified by FLIR were confirmed, 70% for acoustic Doppler, and 95% for CT angiography. The ICCs shows a significant correlation between these imaging techniques and intraoperative results. FLIR demonstrated a strong correlation with intraoperative observations (ICC of 0.74, P<0.001), followed by a moderate correlation with acoustic Doppler (ICC of 0.56, P<0.03) and CT angiography (ICC of 0.52, P<0.006).
The study concludes that thermal imaging with FLIR is a reliable and effective tool for locating vascular perforators. Although the study and FLIR have their own limitations, the tool presents several advantages such as ease of use, speed, and affordability. These characteristics make FLIR particularly attractive as a complement to traditional detection methods, such as acoustic Doppler and CT angiography.
游离皮瓣手术的成功很大程度上取决于术前对穿支动脉的精确 mapping。通常会使用多种成像技术，如多普勒超声和 CT 血管造影，每种技术在成本、准确性和患者风险方面都有其优缺点。我们研究的主要目的是将 FLIR One 设备检测这些动脉的有效性与传统方法进行比较。热成像似乎是一种更简单、成本更低且侵入性更小的手术规划替代方法。
该研究在南锡地区医院中心进行，纳入了 22 名女性患者的 25 个游离皮瓣（腹壁下动脉穿支皮瓣），随访时间为 2022 年至 2023 年。在手术前，进行了腹部盆腔 CT 血管造影，然后在手术前夕使用 FLIR One 进行热成像和声学多普勒检查进行额外评估。这种方法旨在为每位患者提供血管穿支的精确 mapping。由三名不同的操作人员进行这些标记，然后将结果与术中观察结果进行比较。成像方案还包括多普勒检查以验证热成像结果。使用组内相关系数（ICC）进行统计分析，以评估穿支血管不同术前定位方法之间的相关性。
在 22 名接受 25 个用于乳房重建的腹壁下动脉穿支皮瓣手术的患者中，使用了三种成像技术来识别血管穿支：FLIR 热成像、声学多普勒和 CT 血管造影。FLIR 识别出的穿支最多（n = 137），其次是声学多普勒（n = 128）和 CT 血管造影（n = 126）。将这些结果与术中结果进行比较，FLIR 识别出的穿支中有 66%得到证实，声学多普勒为 70%，CT 血管造影为 95%。ICC 显示这些成像技术与术中结果之间存在显著相关性。FLIR 与术中观察结果显示出强相关性（ICC 为 0.74，P < 0.001），其次与声学多普勒有中度相关性（ICC 为 0.56，P < 0.03），与 CT 血管造影有中度相关性（ICC 为 0.52，P < 0.006）。
该研究得出结论，FLIR 热成像是定位血管穿支的可靠且有效工具。尽管该研究和 FLIR 有其自身局限性，但该工具具有诸如易于使用、速度快和成本低等多个优点。这些特性使 FLIR 作为声学多普勒和 CT 血管造影等传统检测方法的补充特别有吸引力。
