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How to Map All Your Flap Perforators in 2 Minutes
Alexander Shikhman, DO, Michael Subichin, MD, Niyant Patel, MD
Summa Health Plastic Surgey Fellowship
2021-01-31
Presenter: Alexander Shikhman, DO
Affidavit:
80% work of presenting fellow
Director Name: Ananth Murthy, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Imaging modalities are changing clinical practice in plastic surgery and becoming more compact, more affordable, and easier to use. Recently, mobile thermal imaging has demonstrated accuracy determining perforator locations and visualizing the functional angiosome. We sought to evaluate whether mobile thermal imaging can be used to rapidly and reliably design perforator flaps.
Using five volunteers, we compared speed and accuracy of traditional anterolateral thigh markings versus thermal markings. Volunteers underwent traditional flap markings on one thigh and thermal imaging after ice cooling on their contralateral thigh. Time to identify three perforators, determination of perforator dominance, and perforator concordance were recorded. Additionally, in two consecutive patients undergoing anterolateral thigh flap reconstruction, flap design was examined based on traditional markings versus thermal imaging.
Perforator identification was more rapid (232 seconds vs 136 seconds) and more likely to demonstrate perforator dominance (5 vs 1) using thermal imaging compared to traditional markings (p<0.05). In both patients undergoing anterolateral thigh flap reconstruction, three perforators were located with traditional and thermal markings. In patient one, the middle perforator demonstrated dominance and true anastomoses to the surrounding perforators. In patient two, the ascending perforator demonstrated maximal intensity and poor connections to the distal perforators. After the proximal perforator was divided, the thermal imaging worsened resulting in resection of the proximal flap and change in flap design.
Thermal imaging appears effective at rapid perforator identification and assisting flap design. Given improvement in technology, mobile thermal imaging may become a reliable tool in flap design and flap monitoring.
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