New perspective on the in vivo use of cold stress dynamic thermography in integumental reconstruction with the use of skin-muscle flaps
Research article published in The Journal of surgical research (2017)
Abstract
BACKGROUND: Among the problems encountered by plastic surgeons is the reconstruction of defects following tumors. One of the reconstructive options is trans rectus abdominis (TRAM) flap. Despite that anatomy is well explored, marginal flap necrosis may develop. To minimize the complications, imaging examinations were designed to determine the degree of flap perfusion. One of them is the thermographic examination. MATERIALS AND METHODS: We examined 38 patients who had undergone 10 reconstructive breast surgeries with a pedicled TRAM ipsilateral flap, 10 patients with a TRAM contralateral flap, and 18 patients with a TRAM supercharged flap. Each operated patient underwent a thermographic examination before the surgery, after the dissection of the skin-muscle flap, immediately after suturing flap, and during the first and seventh day after the surgery. The collected data were then processed to yield results in a numerical form and compared with clinical examination. The aim of this study is to evaluate the efficacy of new thermal model calculation of dTnorm and t90_10 in cold stress dynamic thermography in the in vivo assessment of intraoperative and postoperative skin blood supply in humans before ischemic lesions become clinically apparent. RESULTS: Of 38 patients participating in the study, nine patients developed marginal necrosis of the skin flap despite intraoperative clinical evaluation of blood supply. Explicit circulatory disorders apparent in a clinical examination developed after 24 h. CONCLUSIONS: Cold stress tnorm and t90_10 dynamic thermography can be a helpful additional tool to assess and monitor the blood supply to the flap skin both intraoperatively and postoperatively. Active dynamic thermography; cold stress dynamic thermography, thermography; TRAM; flap necrosis; flap monitoring, breast reconstruction.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This study examined 38 patients undergoing pedicled TRAM breast-reconstruction flaps and tested whether cold-stress dynamic thermography (the dTnorm and t90_10 thermal models) could detect failing skin blood supply before ischemic injury was clinically obvious; nine patients developed marginal flap necrosis despite normal intraoperative clinical assessment, and overt circulatory problems only became clinically apparent after 24 hours, leading the authors to conclude thermography can be a helpful adjunct for monitoring flap perfusion. This matters to hirudotherapy because early detection of compromised flap circulation is precisely the window in which medicinal leeches are applied to decongest a venous-congested flap, so better monitoring tools complement, rather than replace, the salvage role leeches play. The caveat is that this is a small observational perfusion-monitoring study that neither uses nor evaluates leech therapy; it speaks only to the timing and detection of the flap failures that leeching addresses.
Citation
New perspective on the in vivo use of cold stress dynamic thermography in integumental reconstruction with the use of skin-muscle flaps.
Kolacz et al. · The Journal of surgical research, 2017
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