Saleem Ahmed, Philteos Jonas, Lajud Shayanne, Jethwa Ashok, Thomas Carissa, Yao Christopher M L K, Goldstein David P, Higgins Kevin P
Department of Otolaryngology - Head and Neck Surgery University of Toronto Toronto Ontario Canada.
Faculty of Medicine University of Ottawa Ottawa Ontario Canada.
Laryngoscope Investig Otolaryngol. 2025 Jan 21;10(1):e70081. doi: 10.1002/lio2.70081. eCollection 2025 Feb.
The main technique for identification of free flap perforator vessels is Doppler sonography, which is not always accurate, user dependent and affected by the patient's body habitus.
Adult patients undergoing head and neck resection and free flap reconstruction at two academic institutions were enrolled. Doppler sonography was used to identify perforators, and were marked using a skin marker. The donor site was cooled down for 3 min using a sterile iced saline bag. FLIR-ONE (FLIR Systems Inc., Wilsonville, OR) camera was used to assess for "hot spots" during a 3-5 min period of re-warming as a surrogate for cutaneous blood flow. The distance between the Doppler signal location, and the "hot spot" was recorded. The position of the perforator was then identified intraoperatively and the distances between the surgical position, the Doppler and "hot spot" were recorded.
A total of 28 patients were included. For all flap types, FLIR thermal imaging measurements consistently tended to be closer to the surgical site compared to Doppler ultrasound. In anterolateral thigh flaps ( = 20), thoracodorsal artery perforator flaps ( = 5), and fibula osteocutaneous flaps ( = 3), absolute mean differences ranged from 0.62 to 1.33 cm, with trends favoring FLIR. While paired -tests did not reach statistical significance, both methods correlated with intraoperatively identified skin perforators, and distances generally ranged between 0 and 2 cm.
We demonstrate that a smartphone-based thermal imaging system has the potential to serve as an adjunct for identifying flap perforators, with the possibility of reducing operative times and minimizing patient morbidity.
Level 3.
游离皮瓣穿支血管识别的主要技术是多普勒超声检查，其并不总是准确的，依赖操作者，且受患者体型影响。
纳入在两家学术机构接受头颈部切除及游离皮瓣重建的成年患者。使用多普勒超声检查识别穿支血管，并用皮肤标记笔进行标记。使用无菌冰盐水袋将供区冷却3分钟。在复温3 - 5分钟期间，使用FLIR - ONE（FLIR Systems Inc.，威尔逊维尔，俄勒冈州）相机评估“热点”以替代皮肤血流。记录多普勒信号位置与“热点”之间的距离。然后在术中确定穿支血管的位置，并记录手术位置、多普勒信号位置与“热点”之间的距离。
共纳入28例患者。对于所有皮瓣类型，与多普勒超声相比，FLIR热成像测量结果始终更接近手术部位。在股前外侧皮瓣（n = 20）、胸背动脉穿支皮瓣（n = 5）和腓骨骨皮瓣（n = 3）中，绝对平均差异范围为0.62至1.33厘米，趋势有利于FLIR。虽然配对t检验未达到统计学意义，但两种方法均与术中确定的皮肤穿支血管相关，距离一般在0至2厘米之间。
我们证明基于智能手机的热成像系统有潜力作为识别皮瓣穿支血管的辅助手段，有可能减少手术时间并将患者发病率降至最低。
3级。
