Combination of smartphone thermography with Color-Doppler ultrasonography – an easy method for preoperative planning of ALT flaps for novice microsurgeons.

Background: The design and preoperative planning of microsurgical free flaps are crucial for successful outcomes. Studies have shown that preoperative vascular mapping significantly shortens operative time, reduces complication rates, and lowers overall costs. Various methods of perforator detection have been introduced; however, none is ideal. Some surgeons propose that combining two or even three different methods could better meet clinical expectations. Therefore, this study sought to determine the effect of augmenting color Doppler ultrasound (CDUS) preoperative perforator detection with smartphone-based dynamic infrared thermography (DIRT) on concordance with intraoperative findings. Methods: 46 patients scheduled for anterolateral thigh flap (ALTF) reconstruction were included. Patients were divided into two groups according to the method of perforator mapping: Group 1 underwent CDUS alone, while Group 2 underwent DIRT followed by CDUS. Assessments were performed by novice surgeons with limited ultrasound experience. Results: The time required for perforator mapping was significantly shorter in Group 2 (9 min vs. 16 min, p < 0.0001). The mean number of detected perforators in the evaluated area was 2.5 in Group 1 and 2.96 in Group 2 (p = 0.046). Combining CDUS with DIRT significantly reduced the number of overlooked vessels (p < 0.01). Conclusions: DIRT plays an important role in perforator flap planning by identifying likely perforator locations before CDUS. In turn, CDUS provides detailed information on the perforator’s course and hemodynamic properties. The combination of these two techniques offers a rapid, easily interpretable method for preoperative flap planning that can be used by any microsurgeon.

Publication History

Received: 09 April 2025

Accepted after revision: 21 September 2025

Accepted Manuscript online:
10 October 2025