连接智能手机的红外热成像技术在皮瓣移植围手术期检测中的应用

Application of Infrared Thermal Imaging Technology Connected with Smart Phone in the Perioperative Period of Flap Transplantation

目的:探讨连接智能手机的红外热成像技术在皮瓣移植围手术期中的应用价值。方法:2018年1月-2019年1月,笔者科室使用连接智能手机的便携式红外热像仪(FLIR ONE Pro),在10例患者皮瓣移植术围手术期对皮瓣及其轴形血管、穿支血管进行拍摄,并应用FLIR Tools软件进行分析,同时在术中对穿支血管及轴形血管进行验证,计算热成像技术预测皮瓣坏死的敏感性、特异性、准确性、阳性预测值、阴性预测值。结果:本组10例患者有11处软组织缺损,均行皮瓣修复。热成像仪检测结果显示,8处皮瓣血供良好,3处皮瓣血供不佳。血供良好的8处皮瓣,术后观察到1处皮瓣出现部分坏死。血供不佳的3处皮瓣,术后观察到2处皮瓣出现远端表浅坏死,1处皮瓣术后血供好,未发生坏死。在此基础上计算热成像技术预测皮瓣坏死的敏感性为66.7%(2/3),特异性为87.5%(7/8),准确性为81.8%(9/11),阳性预测值为66.7%(2/3),阴性预测值为87.5%(7/8)。术前探测穿支血管16支,术中证实13支;探测10支血管链,术中证实10支血管链。结论:连接智能手机的红外热成像技术在术前探查血管穿支、血管链用于辅助皮瓣设计,术中术后监测皮瓣的皮温、血运以预测、预防皮瓣的坏死方面具有较高的客观性及有效性,可客观有效地辅助外科医生设计皮瓣、评估皮瓣血运,值得临床推广应用。

Objective To explore the application value of infrared thermal imaging technology connected with smart phone in the perioperative period of flap transplantation.Methods From January 2018 to January 2019,the portable infrared thermal imager(FLIR ONE Pro)connected to a smart phone was used to take pictures of the flap and its axial vessels and perforating vessels in 10 patients during the perioperative period of flap transplantation in our department,and FLIR Tools software was used for analysis.At the same time,the perforator vessels and axial vessels were verified during the operation,and the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of thermal imaging technology in predicting flap necrosis were calculated.Results There were 11 soft tissue defects in 10 patients in this group,all of which were repaired with flaps.The results of thermal imaging showed that 8 flaps had good blood supply and 3 flaps had poor blood supply.Among the 8 flaps with good blood supply,partial necrosis was observed in 1 flap after operation.Among the 3 flaps with poor blood supply,2 flaps had superficial necrosis at the distal end after operation,and 1 flap had good blood supply without necrosis.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of thermal imaging in predicting flap necrosis were 66.7%(2/3),87.5%(7/8),81.8%(9/11),66.7%(2/3)and 87.5%(7/8),respectively.Sixteen perforating vessels were detected before operation,and 13 were confirmed during operation.Ten vascular chains were detected and confirmed during operation.Conclusion Smartphone thermal imaging technology has certain objectivity and effectiveness in detecting perforators and vascular chain used to assist skin flap design before operation.Monitoring the skin temperature of the flap after operation has certain objectivity and effectiveness in predicting the necrosis of the flap.It can objectively and effectively assist surgeons to design skin flap and evaluate skin flap blood flow,which is worthy of further clinical application.