Application of infrared thermography technique to assist peroneal artery perforator flap in the repair of oral and maxillofacial defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUO Yun ¹ , CUI Wenjing ¹ , ZONG Kaiyang ¹ ,  LI Jiancheng ¹ , SUN Yue ¹ , HU Kai ¹ , CHEN Mo ¹ , JIANG Ruyi ²

1. Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233004, P. R. China;
2. Department of Stomatology, Bengbu First People’s Hospital, Bengbu Anhui, 233099, P. R. China;

Corresponding author：

LI Jiancheng, Email: ljc7426@163.com

Keywords：

Infrared thermography technique; peroneal artery perforator flap; perforator vessel; repair and reconstruction

DOI：

10.7507/1002-1892.202205032

Video：

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Objective To explore the application value of infrared thermography (IRT) technique assisted peroneal artery perforator flap in repairing oral and maxillofacial defects. Methods The clinical data of 20 patients with oral and maxillofacial malignant tumors treated with peroneal artery perforator flap between October 2020 and December 2021 were retrospectively analysed. There were 13 males and 7 females, with an average age of 56.5 years (range, 32-76 years). There were 8 cases of tongue cancer, 5 cases of parotid gland cancer, 4 cases of buccal cancer, and 3 cases of mandibular gingival cancer; and 12 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, and 5 cases of mucoepidermoid carcinoma. Color Doppler ultrasound (CDU) and IRT technique were performed before operation to locate the peroneal artery perforator and assist in the design of the flap. The sensitivity, specificity, positive predictive value, and negative predictive value of CDU and IRT technique were compared with the actual exploration during operation. The accuracy of CDU and IRT technique in detecting the number of peroneal artery perforator and the most viable perforating points was compared. The patients were followed up regularly to observe the recovery of donor and recipient sites, the occurrence of complications, and the recurrence and metastasis of tumors. Results The sensitivity, specificity, positive predictive value, and negative predictive value of peroneal artery perforators detected by IRT technique before operation were 72.22%, 50.00%, 92.86%, and 16.67% respectively, which were higher than those by CDU (64.17%, 33.33%, 84.62%, and 14.29% respectively). Forty-five peroneal artery perforators were found by CDU before operation, and 35 were confirmed during operation, with an accuracy rate of 77.8%; 43 “hot spots” were found by IRT technique, and 32 peroneal artery perforators were confirmed within the “hot spots” range during operation, with an accuracy rate of 74.4%; there was no significant difference between the two methods (χ²=0.096, P=0.757). The accuracy rates of the most viable perforating points found by CDU and IRT technique were 80.95% (17/21) and 94.74% (18/19), respectively, and there was no significant difference between them (χ²=0.115, P=0.734). The localization errors of CDU and IRT technique were (5.12±2.10) and (4.23±1.87) mm, respectively, and there was no significant difference between them (t=1.416, P=0.165). All the perforator flaps survived, and the incisions of donor and recipient sites healed by first intention. All patients were followed up 5-18 months, with an average of 11 months. The skin flap was soft and had good blood supply, and the lower limb scar was concealed and the lower limb had good function. No lower limb swelling, pain, numbness, ankle instability, or other complications occurred, and no tumor recurrence and metastasis were found during the follow-up. Conclusion Compared with the CDU, using the IRT technique to assist the preoperative peroneal artery perforator flap design to repair the oral and maxillofacial defects has a high clinical application value.

Citation： GUO Yun, CUI Wenjing, ZONG Kaiyang, LI Jiancheng, SUN Yue, HU Kai, CHEN Mo, JIANG Ruyi. Application of infrared thermography technique to assist peroneal artery perforator flap in the repair of oral and maxillofacial defects. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 1015-1020. doi: 10.7507/1002-1892.202205032 Copy

1.	顾玉东, 吴敏明, 李鸿儒. 小腿外侧皮瓣: 附7例报告. 中华医学杂志, 1985, 65(5): 281-283.
2.	Li J, Song P, Yang D, et al. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report. Br J Oral Maxillofac Surg, 2020, 58(3): 355-357.
3.	杨东昆, 李建成, 吴志刚, 等. 游离腓动脉嵌合穿支皮瓣修复腮腺癌晚期局部病变术后缺损. 中国修复重建外科杂志, 2022, 36(1): 79-85.
4.	Kehrer A, Heidekrueger PI, Lonic D, et al. Technical aspects of high-resolution color-coded duplex sonography for the design of perforator flaps. J Reconstr Microsurg, 2022, 38(3): 181-192.
5.	Lozano A, Hayes JC, Compton LM, et al. Determining the thermal characteristics of breast cancer based on high-resolution infrared imaging, 3D breast scans, and magnetic resonance imaging. Sci Rep, 2020, 10(1): 10105. doi: 10.1038/s41598-020-66926-6.
6.	Rahmayani L, Yahya M, Soraya C, et al. Thermal condition of muscle area around the temporomandibular joint in patient with systemic lupus erythematosus using infrared thermography application: A case report. J Int Soc Prev Community Dent, 2020, 10(5): 674-679.
7.	Unger M, Markfort M, Halama D, et al. Automatic detection of perforator vessels using infrared thermography in reconstructive surgery. Int J Comput Assist Radiol Surg, 2019, 14(3): 501-507.
8.	Shokri T, Lighthall JG. Perfusion dynamics in pedicled and free tissue reconstruction: Infrared thermography and laser fluorescence video angiography. Am J Otolaryngol, 2021, 42(2): 102751. doi: 10.1016/j.amjoto.2020.102751.
9.	盛大平, 闫川, 冯涵, 等. 四种血清肿瘤标志物在肺癌诊断中的应用. 中国现代医生, 2021, 59(2): 133-135, 139, 193.
10.	李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果. 南方医科大学学报, 2020, 40(6): 814-821.
11.	Wolff KD, Hölzle F, Nolte D. Perforator flaps from the lateral lower leg for intraoral reconstruction. Plast Reconstr Surg, 2004, 113(1): 107-113.
12.	孙悦, 郭蕴, 李建成, 等. 游离小腿后外侧腓动脉穿支皮瓣在全舌、次全舌切除术后修复中的临床应用. 中华整形外科杂志, 2021, 37(11): 1214-1221.
13.	郭蕴, 孙悦, 李建成, 等. 经口入路口腔-口咽癌切除临床分析. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 712-717.
14.	王珏, 刘海峰, 王旭东, 等. 彩色多普勒超声和CT血管造影技术在下肢穿支皮瓣临床应用中的对比研究. 组织工程与重建外科, 2021, 17(5): 400-404.
15.	Arai K, Fukuda O. Clinical application of thermometers and thermography in plastic surgery. Keisei Geka, 1968, 11(3): 239-250.
16.	Muntean MV, Strilciuc S, Ardelean F, et al. Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators. Med Ultrason, 2015, 17(4): 503-508.
17.	Kolacz S, Moderhak M, Jankau J. New perspective on the in vivo use of cold stress dynamic thermography in integumental reconstruction with the use of skin-muscle flaps. J Surg Res, 2017, 212: 68-76.
18.	Rabbani MJ, Ilyas A, Rabbani A, et al. Accuracy of thermal imaging camera in identification of perforators. J Coll Physicians Surg Pak, 2020, 30(5): 512-515.
19.	许甜甜, 林平, 陈爱兰, 等. 红外热像仪联合高频彩色多普勒超声在股前外侧穿支皮瓣移植术前穿支定位中的应用. 中华手外科杂志, 2018, 34(6): 414-417.
20.	Phillips CJ, Barron MR, Kuckelman J, et al. Mobile smartphone thermal imaging characterization and identification of microvascular flow insufficiencies in deep inferior epigastric artery perforator free flaps. J Surg Res, 2021, 261: 394-399.
21.	肖文天. 红外热成像技术在皮瓣外科中的应用进展. 中华显微外科杂志, 2020, 43(2): 195-199.
22.	徐宏征, 张书诺, 章一新, 等. 红外热成像技术与彩色多普勒超声在股前外侧穿支皮瓣术前穿支血管探测中的比较. 中华显微外科杂志, 2021, 44(4): 388-391.
23.	Chen R, Huang ZQ, Chen WL, et al. Value of a smartphone-compatible thermal imaging camera in the detection of peroneal artery perforators: Comparative study with computed tomography angiography. Head Neck, 2019, 41(5): 1450-1456.
24.	陶船思博, 董凡, 王佃灿, 等. 红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移. 北京大学学报 (医学版), 2019, 51(5): 959-963.

1. 顾玉东, 吴敏明, 李鸿儒. 小腿外侧皮瓣: 附7例报告. 中华医学杂志, 1985, 65(5): 281-283.
2. Li J, Song P, Yang D, et al. Complicated intraoral defects: reconstruction using a three-paddle perforator free flap. A case report. Br J Oral Maxillofac Surg, 2020, 58(3): 355-357.
3. 杨东昆, 李建成, 吴志刚, 等. 游离腓动脉嵌合穿支皮瓣修复腮腺癌晚期局部病变术后缺损. 中国修复重建外科杂志, 2022, 36(1): 79-85.
4. Kehrer A, Heidekrueger PI, Lonic D, et al. Technical aspects of high-resolution color-coded duplex sonography for the design of perforator flaps. J Reconstr Microsurg, 2022, 38(3): 181-192.
5. Lozano A, Hayes JC, Compton LM, et al. Determining the thermal characteristics of breast cancer based on high-resolution infrared imaging, 3D breast scans, and magnetic resonance imaging. Sci Rep, 2020, 10(1): 10105. doi: 10.1038/s41598-020-66926-6.
6. Rahmayani L, Yahya M, Soraya C, et al. Thermal condition of muscle area around the temporomandibular joint in patient with systemic lupus erythematosus using infrared thermography application: A case report. J Int Soc Prev Community Dent, 2020, 10(5): 674-679.
7. Unger M, Markfort M, Halama D, et al. Automatic detection of perforator vessels using infrared thermography in reconstructive surgery. Int J Comput Assist Radiol Surg, 2019, 14(3): 501-507.
8. Shokri T, Lighthall JG. Perfusion dynamics in pedicled and free tissue reconstruction: Infrared thermography and laser fluorescence video angiography. Am J Otolaryngol, 2021, 42(2): 102751. doi: 10.1016/j.amjoto.2020.102751.
9. 盛大平, 闫川, 冯涵, 等. 四种血清肿瘤标志物在肺癌诊断中的应用. 中国现代医生, 2021, 59(2): 133-135, 139, 193.
10. 李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果. 南方医科大学学报, 2020, 40(6): 814-821.
11. Wolff KD, Hölzle F, Nolte D. Perforator flaps from the lateral lower leg for intraoral reconstruction. Plast Reconstr Surg, 2004, 113(1): 107-113.
12. 孙悦, 郭蕴, 李建成, 等. 游离小腿后外侧腓动脉穿支皮瓣在全舌、次全舌切除术后修复中的临床应用. 中华整形外科杂志, 2021, 37(11): 1214-1221.
13. 郭蕴, 孙悦, 李建成, 等. 经口入路口腔-口咽癌切除临床分析. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 712-717.
14. 王珏, 刘海峰, 王旭东, 等. 彩色多普勒超声和CT血管造影技术在下肢穿支皮瓣临床应用中的对比研究. 组织工程与重建外科, 2021, 17(5): 400-404.
15. Arai K, Fukuda O. Clinical application of thermometers and thermography in plastic surgery. Keisei Geka, 1968, 11(3): 239-250.
16. Muntean MV, Strilciuc S, Ardelean F, et al. Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators. Med Ultrason, 2015, 17(4): 503-508.
17. Kolacz S, Moderhak M, Jankau J. New perspective on the in vivo use of cold stress dynamic thermography in integumental reconstruction with the use of skin-muscle flaps. J Surg Res, 2017, 212: 68-76.
18. Rabbani MJ, Ilyas A, Rabbani A, et al. Accuracy of thermal imaging camera in identification of perforators. J Coll Physicians Surg Pak, 2020, 30(5): 512-515.
19. 许甜甜, 林平, 陈爱兰, 等. 红外热像仪联合高频彩色多普勒超声在股前外侧穿支皮瓣移植术前穿支定位中的应用. 中华手外科杂志, 2018, 34(6): 414-417.
20. Phillips CJ, Barron MR, Kuckelman J, et al. Mobile smartphone thermal imaging characterization and identification of microvascular flow insufficiencies in deep inferior epigastric artery perforator free flaps. J Surg Res, 2021, 261: 394-399.
21. 肖文天. 红外热成像技术在皮瓣外科中的应用进展. 中华显微外科杂志, 2020, 43(2): 195-199.
22. 徐宏征, 张书诺, 章一新, 等. 红外热成像技术与彩色多普勒超声在股前外侧穿支皮瓣术前穿支血管探测中的比较. 中华显微外科杂志, 2021, 44(4): 388-391.
23. Chen R, Huang ZQ, Chen WL, et al. Value of a smartphone-compatible thermal imaging camera in the detection of peroneal artery perforators: Comparative study with computed tomography angiography. Head Neck, 2019, 41(5): 1450-1456.
24. 陶船思博, 董凡, 王佃灿, 等. 红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移. 北京大学学报 (医学版), 2019, 51(5): 959-963.

Chinese Journal of Reparative and Reconstructive Surgery

Application of infrared thermography technique to assist peroneal artery perforator flap in the repair of oral and maxillofacial defects

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