[Using a smartphone-compatible thermal camera (FLIR One) for preoperative mapping of DIEP perforators].

IF 0.4 4区 医学 Q4 SURGERY Annales De Chirurgie Plastique Esthetique Pub Date : 2024-10-23 DOI:10.1016/j.anplas.2024.09.002
J Roukoz, G Bilger, M Chatard, F Hollard-Kissel, M Gédor, M Brix, E Simon
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Abstract

Introduction: The success of surgeries involving free flaps largely depends on accurate preoperative mapping of perforator arteries. Various imaging techniques, such as Doppler ultrasound and CT angiography, are typically used, each having its advantages and disadvantages in terms of cost, accuracy, and patient risk. The main objective of our study is to compare the effectiveness of the FLIR One device for detecting these arteries compared with traditional methods. Thermal imaging appears to be a simpler, less expensive, and less invasive alternative for surgical planning.

Material and method: The study, conducted at the Regional Hospital Center of Nancy, included 25 free flaps (DIEP) on an exclusively female cohort of 22 patients, with follow-up from 2022 to 2023. Before the procedure, an abdominal-pelvic CT angiography was performed, followed by additional evaluation with thermal imaging using FLIR One and acoustic Doppler examination on the eve of the operation. This approach aimed to provide precise mapping of vascular perforators for each patient. Three different operators performed these markings, and the results were then compared with intraoperative observations. The imaging protocol also included a Doppler examination to validate the results of the thermal imaging. Statistical analyses with intraclass correlation coefficients (ICC) were performed to evaluate the correlation between different preoperative localization methods of perforating vessels.

Results: In 22 patients undergoing 25 DIEP flaps for breast reconstructions, three imaging techniques were used to identify vascular perforators: thermal imaging with FLIR, acoustic Doppler, and CT angiography. FLIR identified the most perforators (n=137), followed by acoustic Doppler (n=128) and CT angiography (n=126). Comparing these with intraoperative results, 66% of perforators identified by FLIR were confirmed, 70% for acoustic Doppler, and 95% for CT angiography. The ICCs shows a significant correlation between these imaging techniques and intraoperative results. FLIR demonstrated a strong correlation with intraoperative observations (ICC of 0.74, P<0.001), followed by a moderate correlation with acoustic Doppler (ICC of 0.56, P<0.03) and CT angiography (ICC of 0.52, P<0.006).

Conclusion: The study concludes that thermal imaging with FLIR is a reliable and effective tool for locating vascular perforators. Although the study and FLIR have their own limitations, the tool presents several advantages such as ease of use, speed, and affordability. These characteristics make FLIR particularly attractive as a complement to traditional detection methods, such as acoustic Doppler and CT angiography.

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[使用与智能手机兼容的热像仪(FLIR One)绘制 DIEP 穿孔器的术前地图]。
介绍:游离皮瓣手术的成功在很大程度上取决于术前对穿孔动脉的准确测绘。通常会使用多种成像技术,如多普勒超声和 CT 血管造影,每种技术在成本、准确性和患者风险方面各有利弊。我们研究的主要目的是比较 FLIR One 设备与传统方法在检测这些动脉方面的效果。热成像似乎是一种更简单、成本更低、创伤更小的手术规划替代方法:这项研究在南希地区医院中心进行,共对 22 名女性患者进行了 25 例游离皮瓣(DIEP)手术,随访时间为 2022 年至 2023 年。手术前进行腹盆腔 CT 血管造影,手术前夕使用 FLIR One 进行热成像和声学多普勒检查。这种方法旨在为每位患者精确绘制血管穿孔器图。由三名不同的操作员进行标记,然后将结果与术中观察结果进行比较。成像方案还包括多普勒检查,以验证热成像的结果。使用类内相关系数(ICC)进行统计分析,以评估不同术前穿孔血管定位方法之间的相关性:在 22 例接受 25 个 DIEP 皮瓣乳房重建术的患者中,使用了三种成像技术来识别血管穿孔:FLIR 热成像、声学多普勒和 CT 血管造影。红外热成像技术识别出的穿孔最多(137 个),其次是声学多普勒(128 个)和 CT 血管造影(126 个)。将这些结果与术中结果进行比较,发现 66% 的穿孔由 FLIR 确认,70% 的穿孔由声学多普勒确认,95% 的穿孔由 CT 血管造影确认。ICCs 显示这些成像技术与术中结果之间存在显著相关性。FLIR 与术中观察结果具有很强的相关性(ICC 为 0.74,PC 结论:研究得出结论,FLIR 热成像技术是定位血管穿孔器的可靠而有效的工具。虽然这项研究和 FLIR 有其自身的局限性,但该工具具有使用方便、速度快、价格低廉等优点。这些特点使得 FLIR 作为声学多普勒和 CT 血管造影等传统检测方法的补充尤为吸引人。
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来源期刊
CiteScore
1.00
自引率
0.00%
发文量
86
审稿时长
44 days
期刊介绍: Qu''elle soit réparatrice après un traumatisme, pratiquée à la suite d''une malformation ou motivée par la gêne psychologique dans la vie du patient, la chirurgie plastique et esthétique touche toutes les parties du corps humain et concerne une large communauté de chirurgiens spécialisés. Organe de la Société française de chirurgie plastique reconstructrice et esthétique, la revue publie 6 fois par an des éditoriaux, des mémoires originaux, des notes techniques, des faits cliniques, des actualités chirurgicales, des revues générales, des notes brèves, des lettres à la rédaction. Sont également présentés des analyses d''articles et d''ouvrages, des comptes rendus de colloques, des informations professionnelles et un agenda des manifestations de la spécialité.
期刊最新文献
LIPOPULP. The impact of fat grafting on pulp sensitivity in fingertip injuries: A retrospective study of seven patients. Using 320-slice computed tomography to preoperatively investigate the leg perforator arterial system and design a perforator flap for patients with a soft-tissue defect in the leg. [Cutaneous and subcutaneous primary leiomyosarcoma: A retrospective cohort of 26 cases examining clinical data and treatments]. [Impact of the number of pregnancies on the venous outflow of DIEP flap in breast reconstruction: A clinical and CT-scan study]. [Using a smartphone-compatible thermal camera (FLIR One) for preoperative mapping of DIEP perforators].
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