Infrared Thermography for Early Detection of Vascular Compromise in Microvascular and Pedicled Flap Reconstruction

Early detection of vascular compromise is pivotal for successful microvascular flap reconstruction, as tissue necrosis can begin within 6 to 8 hours of circulatory impairment. Although conventional monitoring relies on subjective clinical assessment of color, temperature, and capillary refill-methods with inherent observer variability and diminished utility in patients with darker skin tones-emerging technologies offer potential for more objective evaluation. This study compared the efficacy of infrared thermography (IRT), a noninvasive modality that quantifies perfusion through precise temperature mapping, with traditional clinical methods for postoperative flap monitoring. Given that the critical salvage window is time-limited, with intervention, success rates declining precipitously after 8 hours of ischemia, establishing monitoring protocols with enhanced sensitivity and earlier detection capabilities could significantly improve free flap survival rates and reduce revision surgeries. The efficacy of IRT with conventional clinical methods is compared for post-operative flap monitoring for free and pedicled flaps. This prospective observational study enrolled 40 patients undergoing flap reconstruction between August 2023 and October 2024. Post-operative monitoring included IRT using a forward-looking infrared camera and conventional clinical assessments at standardized intervals. Detection time, sensitivity, specificity, and flap salvage rates were analyzed. Nine of 40 flaps (22.5%) developed vascular compromise. IRT detected complications significantly earlier than clinical methods (34.8 vs 38.8 hours, P = 0.02). IRT demonstrated superior sensitivity (96%) and specificity (89%) compared with clinical assessment. IRT enables earlier detection of vascular compromise compared with conventional clinical methods, potentially improving flap salvage rates. Integration of IRT into standard monitoring protocols may enhance patient outcomes following microvascular and pedicled flap reconstruction.