Mapping of Thoracodorsal Artery Perforators: Accuracy of Thermography and Handheld Doppler.

IF 2.2 3区 医学 Q2 SURGERY
Journal of reconstructive microsurgery Pub Date : 2024-09-01 Epub Date: 2024-02-23 DOI:10.1055/s-0044-1779733
Claudius Illg, Johannes C Heinzel, Markus Denzinger, Ruth C Schäfer, Adrien Daigeler, Sabrina Krauss
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引用次数: 0

Abstract

Background:  The versatile musculocutaneous latissimus dorsi flap and the thoracodorsal artery (TDA) perforator flap have developed into indispensable approaches in reconstructive surgery. While the anatomy of the TDA is consistent, the skin perforators vary in location and course. Dynamic infrared thermography (DIRT) recently gained popularity for perforator identification; however, its use and accuracy in thoracodorsal artery perforator (TDAP) mapping is yet to be determined.

Methods:  TDAPs were visualized in 50 cases by DIRT. Based on the thermographic hotspots, the corresponding perforators were then identified by color duplex ultrasound (CDU) and handheld Doppler in a blinded fashion by two separate examiners.

Results:  The midpoint of all perforator fascia passages was localized 99.7 mm caudal and 13.5 mm medial of the posterior axillary fold. The positive predictive value of perforator identification by dynamic infrared thermography was 86.5% and the correlating perforator fascia passage was 9.9 ± 5.8 mm from the hotspot midpoint, with a maximum of 29 mm. The positive predictive value of perforator identification by handheld Doppler was 95% and the signal was 7.2 ± 5.1 mm from the perforator fascia passage.

Conclusion:  DIRT precisely localizes TDAPs. The fusion with CDU combines both modalities' advantages. The combination with handheld Doppler is a fast way of perforator imaging, decreasing the handheld Dopplers' high false positive rate.

测绘胸背动脉穿孔器:热成像和手持多普勒的准确性。
背景:多功能肌皮背阔肌皮瓣和胸背动脉(TDA)穿孔皮瓣已发展成为整形外科不可或缺的方法。虽然 TDA 的解剖结构是一致的,但皮肤穿孔器的位置和走向却各不相同。最近,动态红外热成像(DIRT)在穿孔器识别方面越来越受欢迎;然而,它在胸背动脉穿孔器(TDAP)绘图中的应用和准确性还有待确定:方法:利用 DIRT 对 50 例病例中的 TDAP 进行观察。方法:通过 DIRT 观察 50 个病例中的 TDAP,然后根据热成像热点,由两名不同的检查者以盲法通过彩色双相超声(CDU)和手持多普勒确定相应的穿孔:结果:所有穿孔筋膜通道的中点均位于腋窝后皱襞尾部 99.7 毫米和内侧 13.5 毫米处。通过动态红外热成像识别穿孔的阳性预测值为86.5%,相关的穿孔筋膜通道距离热点中点为9.9 ± 5.8 mm,最大为29 mm。手持多普勒穿孔器识别的阳性预测值为 95%,信号距离穿孔器筋膜通道为 7.2 ± 5.1 毫米:结论:DIRT 可精确定位 TDAP。结论:DIRT 可精确定位 TDAP,与 CDU 的融合则结合了两种模式的优势。与手持式多普勒相结合是一种快速的穿孔成像方法,可降低手持式多普勒的高假阳性率。
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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
期刊介绍: The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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