Dynamic infrared thermography in free flap surgery: A systematic review

Dynamic infrared thermography (DIRT) is increasingly being utilized for perforator selection and perfusion assessment in reconstructive microsurgery, particularly in procedures such as deep inferior epigastric perforator (DIEP) flap reconstructions. This systematic review evaluates the current evidence regarding the diagnostic performance, clinical applicability, and recent advancements of DIRT in free flap surgery.

A systematic search was conducted in accordance with PRISMA guidelines across the PubMed, Scopus, and Web of Science databases, including studies published up to December 2024. Inclusion criteria comprised primary studies employing DIRT in free flap surgery using a dynamic cold challenge, while static thermography experiments were excluded. Data on study characteristics, diagnostic accuracy, and recent technological developments were extracted and assessed using the QUADAS-2 tool.

A total of 31 studies were included, ranging from case reports to prospective cohort studies. DIRT demonstrated sensitivities between 84 % and 95 % for perforator detection, comparable to computed tomography angiography (CTA) and superior to hand-held Doppler (HHD). Despite limitations such as lower resolution and shallow detection depth, recent innovations, including augmented reality (AR), smartphone integration, and artificial intelligence (AI), offer promising solutions for enhanced reliability and user-friendliness.

DIRT is an effective, non-invasive technique with diagnostic accuracy comparable to CTA for preoperative and intraoperative perforator selection in free flap surgery. Further standardization and large-scale clinical studies are warranted to establish DIRT as a standard diagnostic tool in reconstructive microsurgery.