Use of infrared thermography for the assessment of free flap perforators in autologous breast reconstruction: A systematic review

Abstract

Perforator-based flaps have in recent years become the mainstay of autologous breast reconstruction practice. Imaging modalities ranging from Doppler ultrasound to CT angiography demonstrate varying utility in the preoperative identification and localisation of perforators. Despite these available radiological investigations, finding and quantitatively assessing perforators remain a time-consuming and tedious process that is often complicated by a number of factors including variable anatomy prior surgery and body habitus. Thermographic imaging shows promise as a novel modality for preoperative localisation of perforator vessels. This review summarises the currently available evidence for its application in perforator mapping for abdominal-based autologous breast reconstruction. We discuss the development of the technology over the years, its current use, its advantages and how it may impact on reconstructive breast surgery.

Keywords: Breast reconstruction; DIEP dynamic perforator; Infrared thermography; Mapping location.

Figure 1

Literature review selection/exclusion of Oxford PRISMA flow diagram.

Figure 2

Representative abdominal thermogram recorded using the FLIR One smartphone thermal camera. Brighter colours represent higher temperatures or “hotspots” that indicate the site of DIEA perforating vessels.

Figure 3

Direct perforators with a short intramuscular course may be associated with a bright hotspot (A). Direct perforators at the tendinous intersection have a short intramuscular course and have a calibre larger than the average, and show up as bright hot spots (B). Reproduced from de Weerd et al. with kind permission of the authors.