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Flap surgery, which is widely applied in plastic and reconstructive surgery, involves the transfer of tissue from a donor site to a recipient site while preserving its intrinsic vascular supply. This technique is particularly indicated for the reconstruction of complex anatomical structures, such as the mandible or breast, as well as for the restoration of tissue defects resulting from trauma or surgical resection when local tissue is insufficient to support grafting. In contrast to grafts, which depend on angiogenesis from the recipient bed, flaps maintain viability through their native blood supply, which may be either preserved via a vascular pedicle or re-established through microsurgical anastomosis to recipient vessels [1]. Vascular thrombosis is a severe postoperative complication that may lead to flap ischemia and subsequent tissue necrosis, ultimately resulting in partial or complete flap loss. Clinically, tissue discoloration, including progressive darkening, is a key indicator of cellular death caused by impaired perfusion. Vascular compromise not only represents a primary cause of flap failure but is also reported as the most frequent complication following flap transplantation procedures, underscoring the critical importance of early detection and timely intervention. Upon detection of vascular thrombosis, immediate surgical reexploration is essential to maximize the likelihood of free flap salvage. The success of flap rescue is strongly time-dependent, as prolonged ischemia significantly reduces tissue viability and increases the risk of irreversible necrosis. Therefore, rapid return to the operating room for restoration of blood flow is a critical determinant of clinical outcome [2]. Recent studies have demonstrated that infrared thermography enables significantly earlier detection of flap vascular compromise—often as early as 2 hours postoperatively—compared with conventional clinical examination, which typically identifies compromise no earlier than 6 hours after surgery. Early thermographic detection thus provides a valuable time window for timely intervention and improved salvage rates [3].
This study presents the use of infrared thermography for the intraoperative identification of functional perforator vessels within the transferred flap and for continuous monitoring of their perfusion status during surgery, with the aim of preventing postoperative vascular occlusion. The clinical evaluation was conducted using a FLIR A655SC thermal imaging camera operating in the long-wave infrared (LWIR) range, equipped with a 640 × 480 pixel microbolometer detector capable of detecting temperature differences below 30 mK, allowing for high-resolution, real-time assessment of flap perfusion.
[1] Fu-Chan Wei,Samir Mardini, Flaps and Reconstructive Surgery, 2nd Edition, Elsevier, ISBN 9780323243223, 2016
[2] Chen KT, Mardini S, Chuang DC, Lin CH, Cheng MH, Lin YT, Huang WC, Tsao CK, Wei FC. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg. 2007 Jul;120(1):187-195. doi: 10.1097/01.prs.0000264077.07779.50. PMID: 17572562.
[3] Dang J, Tan C, Pham C, Huang S, Yenikomshian H, Gillenwater TJ. Use of Infrared Thermography for Flap Monitoring: A Systematic Review. Plast Reconstr Surg Glob Open. 2021 Oct 20;9(10 Suppl):164. doi: 10.1097/01.GOX.0000799952.09908.70.
