Abstract
Background The versatile application of local perforator flaps for coverage throughout the lower
extremity has already been well proven. Often a “free-style” approach has been used
to design these flaps, as conventional imaging devices for perforator identification
may be too expensive or unavailable. The recent adaptation of Smartphone thermal digital
imaging may now prove to be a cheaper and more readily available means for identifying
the requisite perforators that will sustain these local flaps.
Methods Over the past year, a prospective study was undertaken of all patients having a local
perforator flap for coverage of a lower extremity defect. Twenty-eight local perforator
flaps involving all subtypes were utilized in 25 patients. Smartphone thermography
was used in all patients preoperatively to identify preferable perforator or vascular
network “hot spots” that allowed appropriate flap design. Intraoperative and postoperative
monitoring was similarly done for all flaps to determine outcomes.
Results All local perforator flaps were based on perforators identified using smartphone
thermography. All flaps (23 or 82.1%) that the thermal digital image predicted 100%
viability totally survived. Five flaps were predicted to have marginal viability,
but two nevertheless survived completely while the others required only minor readjustments.
Peninsular and keystone variety perforator flaps were those most commonly used.
Thermography always facilitated making the correct decision as to whether a proximal-
or distal-based peninsular flap would be superior. Subfascial elevation of cool spots
in keystone flaps were found to be least likely to interfere with flap perfusion.
Conclusion Smartphone thermography is an inexpensive and expeditious means for identification
of “hot spots” that is always used by us to ensure perfusion to lower extremity perforator
local flaps. This is a complementary technique for their safer design, harvest, and
subsequent monitoring in conjunction with more complex screening tools as indicated.
Keywords
smartphone - thermography - local perforator flap - keystone flap - propeller flap
- peninsular flap - island flap
