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. 2019 Dec;8(6):799-805.
doi: 10.21037/gs.2019.12.09.

Dynamic infrared thermography (DIRT) in Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: standardization of the measurement set-up

Filip E F Thiessen  1   2 , Thierry Tondu  1   2 , Nicolas Vermeersch  1 , Ben Cloostermans  3 , Ralv Lundahl  3 , Bart Ribbens  3 , Lawek Berzenji  4 , Veronique Verhoeven  5 , Guy Hubens  6 , Gunther Steenackers  3 , Wiebren A A Tjalma  7
Affiliations

Dynamic infrared thermography (DIRT) in Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: standardization of the measurement set-up

Filip E F Thiessen et al. Gland Surg. 2019 Dec.

Abstract

Breast reconstruction with an autologous free Deep Inferior Epigastric Perforator (DIEP) flap is one of the preferred options following mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap. The current golden standard for perforator mapping is computed tomography angiography (CTA). However, this is a relatively expensive imaging modality that requires intravenous contrast injection and exposes patients to ionizing radiation. More recently, dynamic infrared thermography (DIRT) has been proposed as an alternative imaging modality for perforator identification. DIRT appears to be an ideal alternative technique not only for the identification of the dominant perforators, but also for the mapping of the individual influence of each perforator on the flap perfusion. Multiple studies have been performed with the use of DIRT, unfortunately without standardisation of the measurement set-up. In this technical note we propose a standardised and reproducible measurement set-up for the use of DIRT during breast reconstructions with a free DIEP flap. This set-up can be used pre-, intra- and postoperatively. A standardised measurement set-up will improve the quality of measured data and ensure reproducibility.

Keywords: Breast reconstruction; Deep Inferior Epigastric Perforator flap (DIEP flap); dynamic infrared thermography (DIRT); medical thermography; perforator imaging.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Different cooling methods. (A) Cooling with filled sterile bag; (B) image after cooling with aluminium plate.
Figure 2
Figure 2
Camera positioned in different angles. (A) Perpendicular position of the camera; (B) camera at unknown angle.
Figure 3
Figure 3
Position of the tripod and the camera in the operating room (not disturbing the surgeon during surgery).
Figure 4
Figure 4
Intraoperative measurement with cooling. (A) Cooled abdominal area with the hotspots encircled; (B) 4 minutes after removal of cold challenge. Hotspots encircled.
Figure 5
Figure 5
Intraoperative measurement with clamps. (A) Initial state (immediate after clamp removal); (B) steady state (4 minutes after clamp removal).
Figure 6
Figure 6
Flap anastomosed in steady state. The red line marks the edge of area with good perfusion.
See this image and copyright information in PMC

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