Detection of Perforators Using Thermal Imaging

Background: Perforator flaps are commonly used in reconstructive surgery and require accurate vascular anatomy navigation. Several imaging methods help surgeons, including hand-held Doppler, color Doppler ultrasound, computed tomography, and magnetic resonance angiography. A growing literature supports the efficacy of thermal imaging in identifying perforators. This study assessed the efficacy of thermal imaging and perforator anatomy in four body regions. Methods: Twenty volunteers had their abdomen, sacrum, and both anterolateral thighs assessed for cutaneous perforators using thermal imaging. Key surface landmarks were marked with black crosshairs centered on the umbilicus, superior natal cleft, and traditional anterolateral thigh flap markings. All thermal imaging-identified perforators were marked by red crosses, immediately checked with a hand-held Doppler device, and marked with blue circles if not confirmed. A color digital photograph taken of each region was analyzed. Results: Thermal imaging identified a total of 757 "hotspots," of which 732 (97.0 percent) were confirmed by hand-held Doppler. In 40 anterolateral thighs, the mean number of perforators identified was 1.3 within 2.5 cm and 4.6 within 5 cm of traditional landmarks. In the abdomen, the mean number of perforators was 0.7 and 3.7 within 2.5 cm and 5 cm of the umbilicus, respectively. In the sacral region, there was a mean number of 0.3 and 2.3 perforators within 2.5 cm and 5 cm, respectively, of the superior natal cleft. Conclusions: Thermal imaging is a quick, easy method of assessing cutaneous perforators. It should be considered a useful adjunct, and further investigated, to determine its best role among the established perforator imaging methods.