Comparative study of cooling techniques for perforator detection in DIEP flap reconstruction using dynamic infrared thermography

Dynamic infrared thermography (DIRT) is a non-invasive technique for perforator mapping in Deep Inferior Epigastric artery Perforator (DIEP) flap breast reconstruction. Its accuracy is highly dependent on the cooling technique used to enhance thermal contrast. This study compares eleven cooling techniques based on cooling uniformity, artifact minimization, and usability. Techniques included both conductive and convective approaches and were evaluated using a Pugh Decision Matrix. The top three techniques, including the standard technique, were further assessed in a pilot clinical study. Water-based cooling with neoprene insulation and intensive pre-cooled pad cooling demonstrated the highest uniformity (mean standard deviations of 0.79 and 0.82 °C, respectively) and minimal artifact formation. Pilot clinical validation supported these findings. These techniques offer reliable and practical solutions for enhancing thermal contrast and image clarity in DIRT-based preoperative planning in DIEP flap surgery.