Infrared thermography-assisted design and harvesting of ultrathin anterolateral thigh perforator flaps_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Chenxi ^1,2 ,  PAN Jiadong ^1,2 , YIN Shanqing ^1,2 , SHAO Guoqing ³ , ZHOU Xianting ^1,2 , YU Gaoxiang ^1,2 , WU Luzhe ^1,2 , WANG Xin ^1,2

1. Department of Hand Microsurgery and Plastic Reconstructive Surgery, Ningbo No.6 Hospital, Ningbo Zhejiang, 315043, P. R. China;
2. Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo Zhejiang, 315043, P. R. China;
3. Department of Ultrasonography, Ningbo Sixth Hospital, Ningbo Zhejiang, 315043, P. R. China;

Corresponding?author：

PAN Jiadong, Email: emilon@sina.com

Keywords：

Infrared thermography; ultrathin anterolateral thigh perforator flap; superficial fascia layer perforator

DOI：

10.7507/1002-1892.202506116

Video：

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Objective To explore the application value of infrared thermography in the design and harvesting of ultrathin anterolateral thigh perforator flaps. Methods Between June 2024 and December 2024, 9 cases of ultrathin anterolateral thigh perforator flaps were designed and harvested with the assistance of infrared thermography. There were 7 males and 2 females, aged 21-61 years (mean, 39.8 years). The body mass index ranged from 19.49 to 26.45 kg/m2 (mean, 23.85 kg/m2). Causes of injury included 5 cases of traffic accident injuries and 4 cases of machine crush injuries. There were 3 cases of leg wounds, 2 cases of foot wounds, and 4 cases of hand wounds. After debridement, the size of wound ranged from 7 cm×4 cm to 13 cm×11 cm. The time from admission to flap repair surgery was 5-12 days (mean, 7 days). Preoperatively, perforator localization was performed using a traditional Doppler flow detector and infrared thermography, respectively. The results were compared with the actual intraoperative locations; a discrepancy ≤10 mm was considered as consistent localization (positive), and the positive predictive value was calculated. All 9 cases were repaired with ultrathin anterolateral thigh perforator flaps designed and harvested based on thermographic images. The size of flap ranged from 8 cm×5 cm to 14 cm×8 cm, with a thickness of 3-6 mm (mean, 5.2 mm). One donor site was repaired with a full-thickness skin graft, and the others were sutured directly. Postoperatively, anti-inflammatory, anticoagulant, and anti-vascular spasm treatments were administered, and follow-up was conducted. Results The Doppler flow detector identified 22 perforating vessels within the set range, among which 16 were confirmed as superficial fascia layer perforators intraoperatively, with a positive predictive value of 72.7%. The infrared thermograph detected 23 superficial fascia layer perforating vessels, and 21 were verified intraoperatively, with a positive predictive value of 91.3%. There was no significant difference between the two methods [OR (95%CI)=3.93 (0.70, 22.15), P=0.100]. The perforator localization time of the infrared thermograph was (5.1±1.3) minutes, which was significantly shorter than that of the Doppler flow detector [(10.1±2.6) minutes; MD (95%CI)=–5.00 (–7.08, –2.91), P<0.001]. Postoperatively, 1 case of distal flap necrosis healed after dressing change; all other flaps survived successfully. The skin grafts at donor site survived, and all incisions healed by first intention. All patients were followed up 3-6 months (mean, 4.7 months). No pain or other discomfort occurred at the donor or recipient sites. All patients with foot wounds could walk with shoes, and no secondary flap revision was required. Flaps in 3 hand wound cases, 2 foot wound cases, and 3 leg wound cases recovered light touch and pressure sensation, but not pain or temperature sensation; the remaining 2 cases had no sensory recovery.Conclusion Preoperative localization using infrared thermography for repairing ultrathin anterolateral thigh perforator flaps can help evaluate the blood supply status of perforators, reduce complications, and improve surgical safety and flap survival rate.

Citation： ZHANG Chenxi, PAN Jiadong, YIN Shanqing, SHAO Guoqing, ZHOU Xianting, YU Gaoxiang, WU Luzhe, WANG Xin. Infrared thermography-assisted design and harvesting of ultrathin anterolateral thigh perforator flaps. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(9): 1143-1148. doi: 10.7507/1002-1892.202506116 Copy

1.	王欣, 潘佳棟. 功能性穿支皮瓣的概念與應用. 中華顯微外科雜志, 2024, 47(6): 611-613.
2.	Bae J, Lee JK, Lee KT. Advancing pure-skin-perforator flap application: microscope-free harvesting, versatile donor sites, and clinical outcomes. Plast Reconstr Surg, 2025. doi: 10.1097/PRS.0000000000012215.
3.	Pan Z, Zhao Y, Ye X, et al. Surgical refinements and sensory and functional outcomes of using thinned sensate anterolateral thigh perforator flaps for foot and ankle reconstruction: A retrospective study. Medicine (Baltimore), 2024, 103(37): e38763. doi: 10.1097/MD.0000000000038763.
4.	Zhou JD, Zhang XF, Xu TL, et al. Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site. J Orthop Surg (Hong Kong), 2023, 31(2): 10225536231181706. doi: 10.1177/10225536231181706.
5.	Debelmas A, Camuzard O, Aguilar P, et al. Reliability of Color Doppler ultrasound imaging for the assessment of anterolateral thigh flap perforators: a prospective study of 30 perforators. Plast Reconstr Surg, 2018, 141(3): 762-766.
6.	Pan JD, Xu H, Xiao DC, et al. Perforator detection by thermographic imaging augmented with tourniquet-reperfusion: a modified approach and preliminary report in distal lower leg reconstruction. Ann Plast Surg, 2021, 87(4): 451-456.
7.	Liu Y, Fan W, Yu M, et al. Comparison between mixed reality with artificial algorithms and ultrasound in localization of anterior thigh flap perforators: a prospective randomized controlled study. BMC Med, 2025, 23(1): 374. doi: 10.1186/s12916-025-04181-0.
8.	Xie R, Liu Q, Zhang Y, et al. A wireless infrared thermometry device for postoperative flap monitoring: Proof of concept in a porcine flap model. Int Wound J, 2023, 20(6): 1839-1848.
9.	周賢挺, 潘佳棟, 邵國慶, 等. 改良紅外熱成像技術輔助設計腓動脈穿支螺旋槳皮瓣的臨床應用. 中華顯微外科雜志, 2022, 45(3): 260-265.
10.	Hong Z, Li Z, Zhang X, et al. Optimizing thoracodorsal artery perforator flap outcomes in oncoplastic breast surgery: multidimensional assistive techniques mitigate learning curve and enhance feasibility. Sci Rep, 2025, 15(1): 10937. doi: 10.1038/s41598-025-95073-z.
11.	肖棟超, 潘佳棟, 周賢挺, 等. 止血帶控制再灌注增強紅外熱成像術輔助設計腓腸內側動脈穿支皮瓣的臨床應用. 中華整形外科雜志, 2023, 39(12): 1324-1330.
12.	Mohan AT, Saint-Cyr M. Advances in imaging technologies for planning breast reconstruction. Gland Surg, 2016, 5(2): 242-254.
13.	Fitzgerald O’Connor E, Rozen WM, Chowdhry M, et al. Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications. Gland Surg, 2016, 5(2): 93-98.
14.	劉前圓, 周建東, 王文成, 等. 高頻彩色多普勒超聲探測深層脂肪內穿支輔助超薄股前外側皮瓣切取的前瞻性研究. 中國修復重建外科雜志, 2024, 38(1): 62-68.
15.	謝松林, 唐舉玉, 陶克奇, 等. 游離修薄穿支皮瓣的臨床研究. 中華顯微外科雜志, 2012, 35(4): 321-322.
16.	徐宏征, 張書諾, 章一新, 等. 紅外熱成像技術與彩色多普勒超聲在股前外側穿支皮瓣術前穿支血管探測中的比較. 中華顯微外科雜志, 2021, 44(4): 388-391.
17.	李海, 肖順娥, 鄧呈亮, 等. 紅外熱成像輔助設計旋股外側動脈穿支嵌合皮瓣修復兒童關節復合組織缺損. 中華整形外科雜志, 2025, 41(4): 333-339.
18.	Afzal MO, Haq AU, Riaz MA, et al. Lower extremity reconstruction: utility of smartphone thermal imaging camera in planning perforator based pedicled flaps. J Ayub Med Coll Abbottabad, 2020, 32(Suppl 1): S612-S617.
19.	Chubb DP, Taylor GI, Ashton MW. True and ‘choke’ anastomoses between perforator angiosomes: part Ⅱ. dynamic thermographic identification. Plast Reconstr Surg, 2013, 132(6): 1457-1464.

1. 王欣, 潘佳棟. 功能性穿支皮瓣的概念與應用. 中華顯微外科雜志, 2024, 47(6): 611-613.
2. Bae J, Lee JK, Lee KT. Advancing pure-skin-perforator flap application: microscope-free harvesting, versatile donor sites, and clinical outcomes. Plast Reconstr Surg, 2025. doi: 10.1097/PRS.0000000000012215.
3. Pan Z, Zhao Y, Ye X, et al. Surgical refinements and sensory and functional outcomes of using thinned sensate anterolateral thigh perforator flaps for foot and ankle reconstruction: A retrospective study. Medicine (Baltimore), 2024, 103(37): e38763. doi: 10.1097/MD.0000000000038763.
4. Zhou JD, Zhang XF, Xu TL, et al. Super-thin anterolateral thigh flap for reconstruction of the medial plantar artery perforator flap donor site. J Orthop Surg (Hong Kong), 2023, 31(2): 10225536231181706. doi: 10.1177/10225536231181706.
5. Debelmas A, Camuzard O, Aguilar P, et al. Reliability of Color Doppler ultrasound imaging for the assessment of anterolateral thigh flap perforators: a prospective study of 30 perforators. Plast Reconstr Surg, 2018, 141(3): 762-766.
6. Pan JD, Xu H, Xiao DC, et al. Perforator detection by thermographic imaging augmented with tourniquet-reperfusion: a modified approach and preliminary report in distal lower leg reconstruction. Ann Plast Surg, 2021, 87(4): 451-456.
7. Liu Y, Fan W, Yu M, et al. Comparison between mixed reality with artificial algorithms and ultrasound in localization of anterior thigh flap perforators: a prospective randomized controlled study. BMC Med, 2025, 23(1): 374. doi: 10.1186/s12916-025-04181-0.
8. Xie R, Liu Q, Zhang Y, et al. A wireless infrared thermometry device for postoperative flap monitoring: Proof of concept in a porcine flap model. Int Wound J, 2023, 20(6): 1839-1848.
9. 周賢挺, 潘佳棟, 邵國慶, 等. 改良紅外熱成像技術輔助設計腓動脈穿支螺旋槳皮瓣的臨床應用. 中華顯微外科雜志, 2022, 45(3): 260-265.
10. Hong Z, Li Z, Zhang X, et al. Optimizing thoracodorsal artery perforator flap outcomes in oncoplastic breast surgery: multidimensional assistive techniques mitigate learning curve and enhance feasibility. Sci Rep, 2025, 15(1): 10937. doi: 10.1038/s41598-025-95073-z.
11. 肖棟超, 潘佳棟, 周賢挺, 等. 止血帶控制再灌注增強紅外熱成像術輔助設計腓腸內側動脈穿支皮瓣的臨床應用. 中華整形外科雜志, 2023, 39(12): 1324-1330.
12. Mohan AT, Saint-Cyr M. Advances in imaging technologies for planning breast reconstruction. Gland Surg, 2016, 5(2): 242-254.
13. Fitzgerald O’Connor E, Rozen WM, Chowdhry M, et al. Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications. Gland Surg, 2016, 5(2): 93-98.
14. 劉前圓, 周建東, 王文成, 等. 高頻彩色多普勒超聲探測深層脂肪內穿支輔助超薄股前外側皮瓣切取的前瞻性研究. 中國修復重建外科雜志, 2024, 38(1): 62-68.
15. 謝松林, 唐舉玉, 陶克奇, 等. 游離修薄穿支皮瓣的臨床研究. 中華顯微外科雜志, 2012, 35(4): 321-322.
16. 徐宏征, 張書諾, 章一新, 等. 紅外熱成像技術與彩色多普勒超聲在股前外側穿支皮瓣術前穿支血管探測中的比較. 中華顯微外科雜志, 2021, 44(4): 388-391.
17. 李海, 肖順娥, 鄧呈亮, 等. 紅外熱成像輔助設計旋股外側動脈穿支嵌合皮瓣修復兒童關節復合組織缺損. 中華整形外科雜志, 2025, 41(4): 333-339.
18. Afzal MO, Haq AU, Riaz MA, et al. Lower extremity reconstruction: utility of smartphone thermal imaging camera in planning perforator based pedicled flaps. J Ayub Med Coll Abbottabad, 2020, 32(Suppl 1): S612-S617.
19. Chubb DP, Taylor GI, Ashton MW. True and ‘choke’ anastomoses between perforator angiosomes: part Ⅱ. dynamic thermographic identification. Plast Reconstr Surg, 2013, 132(6): 1457-1464.

Chinese Journal of Reparative and Reconstructive Surgery

Infrared thermography-assisted design and harvesting of ultrathin anterolateral thigh perforator flaps

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