Thermographic Imaging as Applied for Reconstructive Microsurgery

A major roadblock to the advent of choosing perforator flaps in reconstructive surgery was the realization that the vasculature anatomy, even in contralateral sides of the same individual, may be anomalous more often than not. Thus, the “freestyle” approach to the identification of an adequate perforator to sustain these flaps was the common pathway, often time-consuming, and indeed the cause of many undesirable complications. This remains the incentive for the search for better and more reliable means to safely find and incorporate the requisite perforators. Thermography using a thermal imaging camera, now possible when attached to a smartphone, allows an inexpensive, less risky, more expeditious method for even bedside determination of dominant perforator location, with concordance rates similar to that with the use of CT angiography, MR angiography, and even color Duplex or high-frequency ultrasound. This option has been found to be the most valuable when used in the preoperative phase for evaluation of perforator identity.