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CC BY-NC-ND 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0044-1786742
Original Article

Free Flap Monitoring Using Infrared Thermography: An Objective Adjunct to Clinical Monitoring

Priyanka Singla
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Pawan Kumar Dixit 
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Prakash Chandra Kala
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Deepti Katrolia 
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Shilpi Karmakar 
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Akhilesh Humnekar 
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Apoorva Pratap Singh
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Abstract

Background Early detection of free flap compromise is critical for salvage of the flap. Various methods of free flap monitoring have been described, but clinical assessment is the standard method for among all. In this study, role of infrared thermography is evaluated for free flap monitoring.

Methods In patients undergoing free flap surgery, monitoring was done using standard clinical parameters and infrared thermography as per our institutional protocol. Mean temperature difference (∆T) between the flap and the surrounding skin was calculated using the temperature readings from the thermal images intra- and postoperatively. The accuracy of infrared thermography in flap monitoring was assessed in comparison to the standard clinical protocol.

Results Forty-one flaps were included in the analysis, out of which five flaps got compromised. It was observed that the mean temperature difference was higher (mean ∆T 0.20–0.59 vs. 2.38–3.32) when there was a flap compromise, and this temperature difference was evident even before the development of clinical signs. The temperature difference in venous thrombosis (mean ∆T 1.0–2.7) was found to be slightly lower than in arterial insufficiency (mean ∆T 2.1–4.4). For a ∆T cutoff value of 2°C, the thermal camera had a sensitivity of 88.6%, specificity of 98.9%, positive predictive value of 93.9%, and negative predictive value of 97.7%.

Conclusion Infrared thermography is a valuable and noninvasive objective tool in free flap monitoring, which can detect flap compromise (increasing value of ∆T) even before it becomes clinically evident.

Keywords

thermal imaging - free flaps - infrared thermography - free flap monitoring


Publication History

Article published online:
10 May 2024

© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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