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      Concordancia entre termografía con teléfono inteligente y angio-tac para detección de perforantes cutáneas en colgajos diep Translated title: Correlation between smartphone thermography and angio-ct to detect perforators in diep flaps

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          Abstract

          RESUMEN Introducción y objetivo. Existe una gran variedad de técnicas para valorar e identificar perforantes. De todas ellas, la angio-TAC es la prueba considerada como modelo de referencia. La termografía detecta las radiaciones infrarrojas emitidas por los objetos. Esta técnica ha sufrido grandes avances y en la actualidad, está disponible una cámara termal que se puede conectar a lo teléfonos inteligentes. El objetivo del presente estudio es analizar la correlación que existe a la hora de determinar la localización exacta de la salida de las perforantes en colgajos libres DIEP entre la termografía para móviles, en comparación con angio-TAC y entre la termografía y el doppler manual para la localización de perforantes. Material y método. Diseñamos un estudio de tipo observacional descriptivo de evaluación de pruebas diagnósticas con prueba de referencia. Incluimos un total de 14 pacientes, sometidas a reconstrucción mamaria con colgajo libre DIEP en el Servicio de Cirugía Plástica y Reparadora del Hospital Universitario Río Hortega de Valladolid (España), en el periodo comprendido entre septiembre de 2018 y mayo de 2019. Resultados. El coeficiente de correlación de Pearson de la angio-TAC con la termografía fue de 0.866 (p<0.01), y el del doppler con la termografía de 0.952 (p<0.01). El análisis de regresión lineal arrojó los siguientes datos: angio-TAC = 0.804 x termografía. Doppler = 0.982 x termografía, siendo ambas variables dependientes significativas (p< 0.01). Conclusiones. Presentamos un estudio para la realización de un mapeo de perforantes de forma rápida, que necesita un material de bajo coste ya que solo emplea una cámara infrarroja y un teléfono inteligente con conexión mini USB, que requiere un entrenamiento mínimo, y proporciona una buena fiabilidad en comparación con la angio-TAC, considerada como la prueba de referencia en la actualidad.

          Translated abstract

          ABSTRACT Background and objective. A wide range of techniques allow us to assess and identify cutaneous perforators. Out of all of them, angio-CT is the test considered to be gold standard. Thermography detects infrared light from objects. This technique has undergone an enormous advance and is available nowadays as a thermal imager that can be connected to smartphones. Our aim is is to analyze the correlation that exists when determining the exact location of the perforations in DIEP free flaps between mobile thermography compared to angio-CT and between thermography and manual doppler, for the location of perforators Methods. We have carried out a descriptive observational study to assess diagnostic tests with gold standard tests. A total of 14 patients have been included in this study, all of them had undergone breast reconstruction with DIEP technique by the Plastic and Reconstructive Surgery team of Rio Hortega University Hospital in Valladolid (Spain) from September 2018 to May 2019. Results. Pearson correlation coefficient between angio-CT and thermography was 0.866 (p<0.01) and between doppler and thermography was 0.952 (p<0.01). Lineal regression analysis showed: angio-CT = 0.804 x thermography (p<0.01). Doppler = 0.982 x thermograpy (p<0.01). Conclusion. We present a study to map cutaneous perforators in an affordable and quick way, using just an infrared camera and a smartphone. This technique doesn’t require special training and has a good correspondence with angio-CT, which is considered the gold standard technique.

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          Most cited references19

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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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            Detection of Perforators Using Smartphone Thermal Imaging.

            Thermal imaging detects infrared radiation from an object, producing a thermogram that can be interpreted as a surrogate marker for cutaneous blood flow. To date, high-resolution cameras typically cost tens of thousands of dollars. The FLIR ONE is a smartphone-compatible miniature thermal imaging camera that currently retails at under $200. In a proof-of-concept study, patients and healthy volunteers were assessed with thermal imaging for (1) detecting and mapping perforators, (2) defining perforasomes, and (3) monitoring free flaps. Preoperative, intraoperative, and postoperative thermograms can assist in the planning, execution, and monitoring of free flaps, and the FLIR ONE provides a low-cost adjunct that could be applied to other areas of burns and plastic surgery.
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              Detection of Perforators for Free Flap Planning Using Smartphone Thermal Imaging: A Concordance Study with Computed Tomographic Angiography in 120 Perforators.

              Design and preoperative planning of microsurgical flaps are fundamental steps for successful surgery. Currently, computed tomographic angiography is considered the gold standard, and new technologies such as thermography could complement its usefulness. The aim of this study was to determine the concordance between thermographic images obtained with a smartphone thermal camera and computed tomographic angiography for detecting perforators using the anterolateral thigh flap area as a model. A concordance study of diagnostic tests was performed in patients who underwent limb reconstruction in 2016. Perforators identified in thigh computed tomographic angiographic images and hotspots on thermographic images obtained by means of the FLIR ONE smartphone camera were compared based on the distance from the anterior superior iliac spine. The authors studied 20 patients, including 38 anterolateral thigh flap territories in total, and identified 117 perforators by computed tomographic angiography and 120 hotspots by thermography. The average mean distance from the anterior superior iliac spine using these methods was 193.14 mm, and the mean difference in distance was 2.37 mm, with both measurements being obtained within a radius of 20 mm, with a concordance kappa index of 0.975 (p < 0.001). Thermographic imaging presented a sensitivity of 100 percent and a specificity of 98 percent in detecting perforators. Thermographic images obtained with a smartphone thermal camera have a high concordance with the method considered the gold standard for perforator detection. In addition, its sensitivity and specificity are comparable to those of computed tomographic angiography, which makes it a very useful method for mapping perforators in free flap planning.
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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
                March 2020
                : 46
                : 1
                : 53-56
                Affiliations
                [1] orgnameHospital Universitario de Guadalajara orgdiv1Servicio de Cirugía Plástica España
                [2] orgnameHospital Universitario Río Hortega orgdiv1Servicio de Cirugía Plástica España
                [3] orgnameUniversitario Río Hortega orgdiv1Servicio de Cirugía Plástica Hospital España
                Article
                S0376-78922020000100008 S0376-7892(20)04600100008
                10.4321/s0376-78922020000100008
                addd0f9b-43fe-41b7-a953-567c5778a614

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

                History
                : 16 June 2019
                : 19 February 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 4
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Colgajos perforante,Doppler,Angio-TAC,Teléfono inteligente,Smartphone,Thermography,Termografía,Angio-CT,Perforator flaps

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