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The Use of Infrared Thermography in Determining Timing for Early Pedicle Division of the Preexpanded Bipedicled Visor Flap after Ischemic Preconditioning

Lookup NU author(s): Dr Fabio Nicoli



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 Wentian Xiao et al.Background. The preexpanded bipedicled visor flap, supported by the bilateral superficial temporal vessels, stands as an ideal choice for upper and lower lip reconstruction in males. However, the bilateral tissue bridges after flap transfer caused patients significant cosmetic deformity and psychological burden. Early division of bilateral pedicles reduced the length of hospitalization and expenses. In this study, infrared thermography (IRT) was used to guide the early pedicle division after ischemic preconditioning. Methods. This study retrospectively analyzed patients who underwent preexpanded bipedicled visor flap surgery from April 2018 to October 2021. Pedicle division was scheduled at two weeks postflap transfer. Ischemic preconditioning was initiated 3-5 days in advance by repeatedly clamping both pedicles. The temperature alteration of the flap and the temperature difference compared to the normal adjacent tissue were evaluated by IRT. The division surgery was not scheduled until the perfusion assessment indicated adequate. This comprised of subjective examination and indocyanine green angiography. The threshold of temperature difference to determine the pedicle division was analyzed based on the temperature changes between the clamps. Results. A total of 8 male patients successfully conducted the pedicle division without any complications. The delay period after ischemic preconditioning ranged from 14 to 19 days (average 16 days). Through ischemic preconditioning training, the average temperature of the flap gradually increased from 31.85±0.36°C to 33.89±0.50°C, and the temperature difference with the normal surrounding tissues decreased from 2.89±0.30°C to 1.15±0.46°C (95% confidence interval (1.5, 0.8)). The temperature difference stayed unchanged after pedicle division. Conclusion. Ischemic preconditioning shortens the perioperative period to pedicle division. Monitoring the temperature change reflects the revascularization between the flap and the recipient site, thus guiding the pedicle division. The temperature difference less than 1.5°C after clamping both pedicles can be set as the safe threshold for pedicle division.

Publication metadata

Author(s): Xiao W, Zhang S, Li H, Feng S, Nicoli F, Huynh R, Lu J, Zhang Y, Min P

Publication type: Article

Publication status: Published

Journal: Applied Bionics and Biomechanics

Year: 2022

Volume: 2022

Online publication date: 26/07/2022

Acceptance date: 09/07/2022

Date deposited: 23/08/2022

ISSN (print): 1176-2322

ISSN (electronic): 1754-2103

Publisher: Hindawi Limited


DOI: 10.1155/2022/8564922


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