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

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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.	顧玉東, 吳敏明, 李鴻儒. 小腿外側皮瓣: 附7例報告. 中華醫學雜志, 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.	楊東昆, 李建成, 吳志剛, 等. 游離腓動脈嵌合穿支皮瓣修復腮腺癌晚期局部病變術后缺損. 中國修復重建外科雜志, 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, 閆川, 馮涵, 等. 四種血清腫瘤標志物在肺癌診斷中的應用. 中國現代醫生, 2021, 59(2): 133-135, 139, 193.
10.	李建成, 宋培軍, 楊東昆, 等. 游離腓動脈雙葉穿支皮瓣在晚期口咽癌術后缺損解剖重建中的臨床效果. 南方醫科大學學報, 2020, 40(6): 814-821.
11.	Wolff KD, H?lzle F, Nolte D. Perforator flaps from the lateral lower leg for intraoral reconstruction. Plast Reconstr Surg, 2004, 113(1): 107-113.
12.	孫悅, 郭蘊, 李建成, 等. 游離小腿后外側腓動脈穿支皮瓣在全舌、次全舌切除術后修復中的臨床應用. 中華整形外科雜志, 2021, 37(11): 1214-1221.
13.	郭蘊, 孫悅, 李建成, 等. 經口入路口腔-口咽癌切除臨床分析. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(8): 712-717.
14.	王玨, 劉海峰, 王旭東, 等. 彩色多普勒超聲和CT血管造影技術在下肢穿支皮瓣臨床應用中的對比研究. 組織工程與重建外科, 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.	許甜甜, 林平, 陳愛蘭, 等. 紅外熱像儀聯合高頻彩色多普勒超聲在股前外側穿支皮瓣移植術前穿支定位中的應用. 中華手外科雜志, 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. 紅外熱成像技術在皮瓣外科中的應用進展. 中華顯微外科雜志, 2020, 43(2): 195-199.
22.	徐宏征, 張書諾, 章一新, 等. 紅外熱成像技術與彩色多普勒超聲在股前外側穿支皮瓣術前穿支血管探測中的比較. 中華顯微外科雜志, 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, 王佃燦, 等. 紅外熱成像技術診斷口腔鱗狀細胞癌頸淋巴結轉移. 北京大學學報 (醫學版), 2019, 51(5): 959-963.

1. 顧玉東, 吳敏明, 李鴻儒. 小腿外側皮瓣: 附7例報告. 中華醫學雜志, 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. 楊東昆, 李建成, 吳志剛, 等. 游離腓動脈嵌合穿支皮瓣修復腮腺癌晚期局部病變術后缺損. 中國修復重建外科雜志, 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, 閆川, 馮涵, 等. 四種血清腫瘤標志物在肺癌診斷中的應用. 中國現代醫生, 2021, 59(2): 133-135, 139, 193.
10. 李建成, 宋培軍, 楊東昆, 等. 游離腓動脈雙葉穿支皮瓣在晚期口咽癌術后缺損解剖重建中的臨床效果. 南方醫科大學學報, 2020, 40(6): 814-821.
11. Wolff KD, H?lzle F, Nolte D. Perforator flaps from the lateral lower leg for intraoral reconstruction. Plast Reconstr Surg, 2004, 113(1): 107-113.
12. 孫悅, 郭蘊, 李建成, 等. 游離小腿后外側腓動脈穿支皮瓣在全舌、次全舌切除術后修復中的臨床應用. 中華整形外科雜志, 2021, 37(11): 1214-1221.
13. 郭蘊, 孫悅, 李建成, 等. 經口入路口腔-口咽癌切除臨床分析. 臨床耳鼻咽喉頭頸外科雜志, 2021, 35(8): 712-717.
14. 王玨, 劉海峰, 王旭東, 等. 彩色多普勒超聲和CT血管造影技術在下肢穿支皮瓣臨床應用中的對比研究. 組織工程與重建外科, 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. 許甜甜, 林平, 陳愛蘭, 等. 紅外熱像儀聯合高頻彩色多普勒超聲在股前外側穿支皮瓣移植術前穿支定位中的應用. 中華手外科雜志, 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. 紅外熱成像技術在皮瓣外科中的應用進展. 中華顯微外科雜志, 2020, 43(2): 195-199.
22. 徐宏征, 張書諾, 章一新, 等. 紅外熱成像技術與彩色多普勒超聲在股前外側穿支皮瓣術前穿支血管探測中的比較. 中華顯微外科雜志, 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, 王佃燦, 等. 紅外熱成像技術診斷口腔鱗狀細胞癌頸淋巴結轉移. 北京大學學報 (醫學版), 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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