Digital Infrared Thermal Imaging Assistance for Laryngectomy and Neck Dissection Flap Monitoring in Elderly Patients

Objective: In flap survival, close postoperatively monitoring of neck flaps is essential; instant action increases the rate of flap salvage. The purpose of this research was to assess the ability of digital infrared thermal Imaging and software during laryngectomy and neck dissection monitoring to detect failure of neck flaps.
Methods: Twelve elderly patients who required total laryngectomy and bilateral neck dissection for advanced laryngeal cancer participated in this study. The hourly clinical examination of skin colour, capillary refilling and turgor were evaluated for both flaps. In addition, thermal images were taken synchronously with the digital camera. Such images were processed and analyzed as an indication of flap failure on their additional value.
Results: Out of 12 flaps, one failed due to hematoma, and venous congestion formed in two flaps. The mean flap temperature demonstrated to be most predictive of flap failing relative to the adjacent control skin. In contrast to the uncompromised flaps, both failed flaps demonstrated lower temperatures after failure.
Conclusion: An efficient thermal camera imaging can possibly improve post-operative flap monitoring. It could play an additional part in the non-invasive early diagnosis of flap failure if used in conjunction with other modalities. By analyzing relative differences in temperature between the flap and reference tissue, vascular occlusion in flaps may be differentiated.