Thermal Imaging Facilitates Design of a Keystone Perforator Island Flap for a Myxofibrosarcoma Resection Reconstruction: Case Report
Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use therma...
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| Published in: | Plastic and reconstructive surgery. Global open Vol. 7; no. 8; p. e2359 |
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The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons
01-08-2019
Copyright The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved Wolters Kluwer Health |
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| Abstract | Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use thermal imaging to localize “hot spots” on the skin, corresponding to perforators. FLIR ONE (FLIR Systems Inc., Wilsonville, OR) is a portable thermal camera with high concordance with computed tomographic angiography. In this case, when faced with handheld Doppler failure, we used intraoperative thermal imaging to continue planning and raising of a complex lower extremity keystone perforator island flap. |
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| AbstractList | Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use thermal imaging to localize “hot spots” on the skin, corresponding to perforators. FLIR ONE (FLIR Systems Inc., Wilsonville, OR) is a portable thermal camera with high concordance with computed tomographic angiography. In this case, when faced with handheld Doppler failure, we used intraoperative thermal imaging to continue planning and raising of a complex lower extremity keystone perforator island flap. Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use thermal imaging to localize "hot spots" on the skin, corresponding to perforators. FLIR ONE (FLIR Systems Inc., Wilsonville, OR) is a portable thermal camera with high concordance with computed tomographic angiography. In this case, when faced with handheld Doppler failure, we used intraoperative thermal imaging to continue planning and raising of a complex lower extremity keystone perforator island flap.Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use thermal imaging to localize "hot spots" on the skin, corresponding to perforators. FLIR ONE (FLIR Systems Inc., Wilsonville, OR) is a portable thermal camera with high concordance with computed tomographic angiography. In this case, when faced with handheld Doppler failure, we used intraoperative thermal imaging to continue planning and raising of a complex lower extremity keystone perforator island flap. |
| Author | Homsy, Christopher Chaffin, Abigail E. Atamian, Elisa K. Patel, Shimul S. |
| AuthorAffiliation | Tulane University School of Medicine, New Orleans, La From the Division of Plastic Surgery, Tulane University Medical Center, New Orleans, La |
| AuthorAffiliation_xml | – name: From the Division of Plastic Surgery, Tulane University Medical Center, New Orleans, La – name: Tulane University School of Medicine, New Orleans, La |
| Author_xml | – sequence: 1 givenname: Shimul S. surname: Patel fullname: Patel, Shimul S. organization: From the Division of Plastic Surgery, Tulane University Medical Center, New Orleans, La – sequence: 2 givenname: Christopher surname: Homsy fullname: Homsy, Christopher organization: From the Division of Plastic Surgery, Tulane University Medical Center, New Orleans, La – sequence: 3 givenname: Elisa K. surname: Atamian fullname: Atamian, Elisa K. organization: Tulane University School of Medicine, New Orleans, La – sequence: 4 givenname: Abigail E. surname: Chaffin fullname: Chaffin, Abigail E. organization: From the Division of Plastic Surgery, Tulane University Medical Center, New Orleans, La |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31592380$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.4103/0970-0358.105959 10.2174/1874325001408010423 10.1007/s00266-007-0072-9 10.1016/j.cps.2011.03.013 10.1097/PRS.0000000000002719 10.1097/01.prs.0000232216.34854.63 10.1097/GOX.0000000000001228 10.1002/micr.30047 10.1097/PRS.0000000000004126 10.1111/j.1445-2197.2007.04382.x |
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| Copyright | The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved. Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. 2019 |
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| References | Jordan (R2-20230807) 2014; 8 Yu (R8-20230807) 2006; 118 Hardwicke (R10-20230807) 2016; 138 Behan (R4-20230807) 2008; 78 Bhattacharya (R5-20230807) 2012; 45 Pu (R1-20230807) 2017; 5 Pereira (R6-20230807) 2018; 141 Khan (R7-20230807) 2007; 31 Bekara (R3-20230807) 2018; 38 de Weerd (R9-20230807) 2011; 38 |
| References_xml | – volume: 45 start-page: 494 year: 2012 ident: R5-20230807 article-title: CT angiographic evaluation of perforators in the lower limb and their reconstructive implication. publication-title: Indian J Plast Surg doi: 10.4103/0970-0358.105959 contributor: fullname: Bhattacharya – volume: 8 start-page: 423 year: 2014 ident: R2-20230807 article-title: Flap decisions and options in soft tissue coverage of the lower limb. publication-title: Open Orthop J doi: 10.2174/1874325001408010423 contributor: fullname: Jordan – volume: 31 start-page: 521 year: 2007 ident: R7-20230807 article-title: Reliability of handheld Doppler in planning local perforator-based flaps for extremities. publication-title: Aesthetic plastic surgery doi: 10.1007/s00266-007-0072-9 contributor: fullname: Khan – volume: 38 start-page: 277 year: 2011 ident: R9-20230807 article-title: Dynamic infrared thermography. publication-title: Clin Plast Surg doi: 10.1016/j.cps.2011.03.013 contributor: fullname: de Weerd – volume: 138 start-page: 940e year: 2016 ident: R10-20230807 article-title: Reply: detection of perforators using smartphone thermal imaging. publication-title: Plast Reconstr Surg doi: 10.1097/PRS.0000000000002719 contributor: fullname: Hardwicke – volume: 118 start-page: 928 year: 2006 ident: R8-20230807 article-title: Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. publication-title: Plast Reconstr Surg doi: 10.1097/01.prs.0000232216.34854.63 contributor: fullname: Yu – volume: 5 start-page: e1228 year: 2017 ident: R1-20230807 article-title: A comprehensive approach to lower extremity free-tissue transfer. publication-title: Plast Reconstr Surg Glob Open doi: 10.1097/GOX.0000000000001228 contributor: fullname: Pu – volume: 38 start-page: 109 year: 2018 ident: R3-20230807 article-title: Free versus perforator-pedicled propeller flaps in lower extremity reconstruction: what is the safest coverage? A meta-analysis. publication-title: Microsurgery doi: 10.1002/micr.30047 contributor: fullname: Bekara – volume: 141 start-page: 787 year: 2018 ident: R6-20230807 article-title: Detection of perforators for free flap planning using smartphone thermal imaging: a concordance study with computed tomographic angiography in 120 perforators. publication-title: Plast Reconstr Surg doi: 10.1097/PRS.0000000000004126 contributor: fullname: Pereira – volume: 78 start-page: 116 year: 2008 ident: R4-20230807 article-title: Evolution of the fasciocutaneous island flap leading to the keystone flap principle in lower limb reconstruction. publication-title: ANZ J Surg doi: 10.1111/j.1445-2197.2007.04382.x contributor: fullname: Behan |
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| Snippet | Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler... |
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| Title | Thermal Imaging Facilitates Design of a Keystone Perforator Island Flap for a Myxofibrosarcoma Resection Reconstruction: Case Report |
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