Smartphone Thermal Imaging as an Adjunct to Identify Free Flap Perforators and Assisting Flap Design: A Pilot Study

Area of Science:

• Microsurgery
• Vascular Surgery
• Medical Imaging

Background:

• Doppler sonography is the primary method for identifying free flap perforator vessels.
• This technique has limitations including inaccuracy, user dependency, and influence from patient body habitus.

Purpose of the Study:

• To evaluate the efficacy of smartphone-based thermal imaging as an adjunct for perforator vessel identification.
• To compare the accuracy of thermal imaging with Doppler sonography in locating perforators for free flap reconstruction.

Main Methods:

• Adult patients undergoing head and neck resection and free flap reconstruction were enrolled.
• Doppler sonography and FLIR thermal imaging were used to identify and mark perforators.
• Distances between marked and intraoperatively identified perforator positions were recorded for both methods.

Main Results:

• Thermal imaging measurements were consistently closer to the surgically identified perforator sites than Doppler ultrasound.
• For various flap types, the mean difference between thermal imaging and surgical position ranged from 0.62 to 1.33 cm.
• Both methods correlated with intraoperatively identified perforators, with distances generally within 0-2 cm.

Conclusions:

• Smartphone-based thermal imaging shows potential as an adjunct tool for perforator vessel identification.
• This technology may help reduce operative times and minimize patient morbidity in free flap surgery.