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. 2024 Jul 5;14(7):730.
doi: 10.3390/jpm14070730.

Perfusion in Pedicled Skin Flaps: Initial Insights from Smartphone-Based Thermal Imaging Protocol

Lukas S Fiedler  1   2 , Burkard M Lippert  1 , Lukas Adrian  1 , Tobias Meyer  3
Affiliations

Perfusion in Pedicled Skin Flaps: Initial Insights from Smartphone-Based Thermal Imaging Protocol

Lukas S Fiedler et al. J Pers Med. .

Abstract

Objective: Successful outcomes in head and neck surgery rely on maintaining perfusion in pedicled skin flaps. Thermal imaging offers a noninvasive means to assess tissue perfusion, potentially aiding in predicting flap viability. This pilot study explores the utility of SBTI (smartphone-based thermal imaging) for predicting flap vitality and monitoring during surgery.

Methods: Thermal imaging was employed using the FLIR One System. An imaging protocol was established, defining points of interest (T1-T4) on pedicled skin flaps. Conducted over four months, the study integrated SBTI into reconstructive surgery for the face, head and neck defects post-tumor resections. SBTI's effectiveness was assessed with n = 11 pedicled flaps, capturing images at key stages and correlating them with clinical flap assessment. Thermal images were retrospectively graded by two surgeons, evaluating flap perfusion on a scale from 1 to 5, based on temperature differences (1 = ΔT < 2 °C, 2 = ΔT ≥ 2 °C, 3 = ΔT ≥ 4 °C, 4 = ΔT ≥ 6 °C, and 5 = ΔT ≥ 8 °C), with assessments averaged for consensus and compared with the clinical assessment control group.

Results: The study encountered challenges during implementation, leading to the exclusion of six patients. Patient data included 11 cases with n = 44 SBTI images. Intraoperative assessments consistently showed good perfusion. One postoperative dehiscence was noted, which retrospectively coincided with intraoperative SBTI grading, but not with clinical assessment. Statistical analysis indicated consistent outcomes following clinical and SBTI assessments. Thermal imaging accurately predicted flap viability, although it had limitations with small flaps.

Conclusion: SBTI proved effective, inexpensive, and noninvasive for assessing tissue perfusion, showing promise for predicting flap viability and intraoperative monitoring in head and neck surgery.

Keywords: pedicled flaps; perfusion; skin flaps; smartphone diagnostics; thermal imaging.

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Conflict of interest statement

Lukas S. Fiedler, Lukas Adrian, Burkard M. Lippert and Tobias Meyer declared that they have no conflicts of interest related to this manuscript. No financial or personal relationships with other people or organizations could potentially influence their objectivity in conducting or reporting the research described in the manuscript. All potential sources of conflicts of interest have been disclosed by the journal’s guidelines. The authors declare any potential conflicts of interest related to this research. This encompasses financial interests, such as patent or stock ownership, board memberships, advisory roles, and consultancy or speaker fees from companies.

Figures

Figure 1
Figure 1
SBTI algorithm.
Figure 2
Figure 2
Implemented SBTI algorithm T1–4, showing the intraoperative picture in correlation to the SBTI picture.
Figure 3
Figure 3
Rainbow temperature scale.
Figure 4
Figure 4
Perioperative thermal imaging in a random pattern flap with the FLIR one Pro Camera preoperatively (left), after flap elevation, after reconstruction, and 24 h after surgery (right) showing good perfusion due to the red color and minor yellow area in the periphery, which shows a low delta between normal and flap temperature.
Figure 5
Figure 5
Perioperative thermal imaging in a combined reconstruction preoperatively (left), after flap elevation (middle), and after reconstruction (right) showing good perfusion due to a homogenous yellowish color emitted by the flaps (modified Hatchet and Esser flap).
See this image and copyright information in PMC

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