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      Termografía portátil en Cirugía Plástica: el nuevo estetoscopio del cirujano reconstructivo Translated title: Portable thermography in Plastic Surgery: the new reconstructive surgeon’s stetho-scope

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          Abstract

          Resumen Introducción y Objetivo. La termografía puede medir la longitud de onda de la radiación infrarroja emitida desde el cuerpo y calcular su temperatura. Es un método pasivo, no invasivo y no emite radiación ionizante. La mayoría de los estudios en Cirugía Plástica han investigado su utilidad en la localización de perforantes y en la evaluación de la profundidad de las quemaduras. La termografía portátil tiene la ventaja de su bajo costo y de poder ser utilizada junto a la cama del paciente. El objetivo de este estudio es presentar nuestra experiencia en el uso de la termografía portátil y realizar una revisión respecto a las aplicaciones de esta tecnología en Cirugía Plástica Reconstructiva. Material y método. Estudio descriptivo basado en la experiencia acumulada sobre el uso de termografía portátil para teléfonos inteligentes en Cirugía Plástica Reconstructiva desde enero de 2017 a diciembre de 2019. Resultados. Describimos la utilidad de la termografía portátil en la planificación de colgajos basados en perforantes, monitorización de colgajos, definición del momento óptimo para realizar el segundo tiempo en colgajos retardados, así como la evaluación de la vitalidad de tejidos en lesiones por desforramiento y quemaduras eléctricas. Conclusiones. La termografía portátil es rápida y fiable en la detección de perforantes y en la diferenciación entre tejidos vitales y necróticos o isquémicos. Es complementaria a otras técnicas imagenológicas, ahorra tiempo en el mapeo o rastreo de perforantes y proporciona además información útil en la estimación de la perfusión de tejidos.

          Translated abstract

          Abstract Background and objective. Thermography can measure the wave length of infrared radiation emitted from the body and calculate its temperature. It is a passive method, noninvasive, that does not emit ionizing radiation. Most studies in Plastic Surgery have researched its utility in localization of perforators and evaluation of burn depth. Portable thermography has the advantage of having a lower cost, and being able to be performed bedside. The aim of this study is to present our experience with portable thermography and review the uses of this technology in Reconstructive Plastic Surgery. Methods. Descriptive study based on the accumulated experience on the use of portable thermography for smartphones in Reconstructive Plastic Surgery, from January 2017 to December 2019. Results. We describe the utility of portable thermography in planning flaps based on perforators, flap monitoring, definition of the optimal timing for secondstage operations in vascular delay procedures, as well as assessment of the vitality of tissues in degloving injuries and electrical burns. Conclusions. Portable thermography is reliable and fast in detecting perforators and defining viable and ischemic/necrotic tissue. It is complementary to other imaging techniques, saving time in mapping or tracing perforators and provides useful information in estimating well-perfused tissue.

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          Most cited references21

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          The Keystone Design Perforator Island Flap in reconstructive surgery.

          A surgical technique for closing skin defects following skin cancer (particularly melanoma) removal is described in the present paper. Its use is illustrated in five patients. The technique has been used in 300 cases over the past 7 years and is suitable for all areas of the body from scalp to foot. We have coined the term Keystone Design Perforator Island Flap (KDPIF) because of its curvilinear shaped trapezoidal design borrowed from architectural terminology. It is essentially elliptical in shape with its long axis adjacent to the long axis of the defect. The flap is based on randomly located vascular perforators. The wound is closed directly, the mid-line area is the line of maximum tension and by V-Y advancement of each end of the flap, the 'islanded' flap fills the defect. This allows the secondary defect on the opposite side to be closed, exploiting the mobility of the adjacent surrounding tissue. The importance of blunt dissection is emphasized in raising these perforator island flaps as it preserves the vascular integrity of the musculocutaneous and fasciocutaneous perforators together with venous and neural connections. The keystone flap minimizes the need for skin grafting in the majority of cases and produces excellent aesthetic results. Four types of flaps are described: Type I (direct closure), Type II (with or without grafting), Type III (employs a double island flap technique), and Type IV (involves rotation and advancement with or without grafting). The patient is almost pain free in the postoperative phase. Early mobilization is possible, allowing this technique to be used in short stay patients. In a series of 300 patients with flaps situated over the extremities, trunk and facial region, primary wound healing was achieved in 99.6% with one out of 300 developing partial necrosis of the flap. The technique described in the present article offers a simple and effective method of wound closure in situations that would otherwise have required complex flap closure or skin grafting particularly for melanoma.
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            Dynamic infrared thermography.

            This article describes how dynamic infrared thermography (DIRT) can be used in autologous breast reconstruction with a deep inferior epigastric perforator flap. This noninvasive and noncontact technique for indirect monitoring of skin blood perfusion can be used in the preoperative planning and intraoperative evaluation of flap perfusion, as well as the postoperative monitoring of perfusion dynamics of DIEP flaps. DIRT provides valuable information on the perfusion physiology of perforators. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Vascular delay revisited.

              The technique of vascular delay has been used by plastic surgeons for nearly 500 years and has proven useful for reliably transferring tissue and allowing for a greater volume of tissue to be reliably harvested. Delay procedures are an essential plastic surgical tool for a variety of aesthetic and reconstructive procedures. Despite the widespread use of vascular delay procedures, the mechanism by which this phenomenon occurs remains unclear. A number of groups have exhaustively examined microvascular changes that occur during vascular delay. Theories have been proposed ranging from the dilation of choke vessels to changes in metabolism and new blood vessel formation. Inherent in these theories is the concept that ischemia is able to act as the primary stimulus for vascular changes. The purpose of this review is to revisit the theories proposed to underlie the delay phenomenon in light of recent advances in vascular biology. In particular, the participation of bone marrow-derived endothelial progenitor cells in the delay phenomenon is explored. Greater understanding of the role these cells play in new blood vessel formation will be of considerable clinical benefit to high-risk patients in future applications of delay procedures.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2020
                : 46
                : 3
                : 319-328
                Affiliations
                [3] Santiago orgnameHospital de Urgencia Asistencia Pública orgdiv1Servicio de Quemados Chile
                [4] Santiago orgnameHospital del Trabajador orgdiv1Departamento de Cirugía Plástica y Quemados Chile
                [1] Santiago Santiago de Chile orgnameClínica Las Condes orgdiv1Departamento de Cirugía Plástica Chile
                [2] Santiago Santiago orgnameHospital San Juan de Dios orgdiv1Servicio de Cirugía Chile
                Article
                S0376-78922020000400008 S0376-7892(20)04600300008
                10.4321/s0376-78922020000400008
                194fec54-0a69-4cbe-a669-a81381de1832

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 19 August 2020
                : 09 April 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 10
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Termografía,Colgajos perforantes,Perfusión tisular,Thermography,Thermal imaging,Free flaps,Perforator flaps,Tissue perfusion,Colgajos libres,Imagen térmica

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