| Objective:To explore the application value of infrared thermography(IRT)technique assisted peroneal artery perforator flap in repairing oral and maxillofacial defects.Methods:The clinical data of 20 patients with oral and maxillofacial malignant tumors treated with peroneal artery perforator flap between October 2020 and December 2021 were analysed.There were 13 males and 7 females,with an average age of 56.5 years(range,32-76 years).There were 8 cases of tongue cancer,5 cases of parotid gland cancer,4 cases of buccal cancer,and 3 cases of mandibular gingival cancer;and 12 cases of squamous cell carcinoma,3 cases of adenoid cystic carcinoma,and 5 cases of mucoepidermoid carcinoma.Color Doppler ultrasound(CDU)and IRT technique were performed before operation to locate the peroneal artery perforator and assist in the design of the flap.Observe whether there is any variation or deletion in the anatomy of the perforating branch of the peroneal artery during the operation,and analyze the sensitivity,specificity,positive predictive value,and negative predictive value of CDU and IRT technique;The accuracy of CDU and IRT technique in detecting the number of peroneal artery perforator and the most viable perforating points was compared.On the 7th day after operation,IRT technology was used to monitor the blood flow of the flap in real time,record the survival of the flap,and analyze the thermal imaging images of the flap.The blood flow characteristics of the flap on the 7th day after operation were summarized,and the clinical application value of IRT technology was evaluated.The patients were followed up regularly to observe the recovery of donor and recipient sites,the occurrence of complications,and the recurrence and metastasis of tumors.Results:1.One patient had variation in the peroneal artery and no exploration was found.The sensitivity,specificity,positive predictive value,and negative predictive value of peroneal artery perforators detected by IRT technique before operation were 72.22%,50.00%,92.86%,and 16.67%respectively,which were higher than those by CDU(64.17%,33.33%,84.62%,and 14.29%respectively).2.45 peroneal artery perforators were found by CDU before operation,and 35 were confirmed during operation,with an accuracy rate of 77.78%;43 "hot spots" were found by IRT technique,and 32 peroneal artery perforators were confirmed within the "hot spots" range during operation,with an accuracy rate of 74.42%;there was no significant difference between the two methods(χ2=0.096,P=0.757).The accuracy rates of the most viable perforating points found by CDU and IRT technique were 80.95%(17/21)and 94.74%(18/19),respectively,and there was no significant difference between them(χ2=0.115,P=0.734).The localization errors of CDU and IRT technique were(5.12±2.10)and(4.23±1.87)mm,respectively,and there was no significant difference between them(t=1.416,P=0.165).3.All flaps survived,and the blood supply of the flap was good 7 days after the operation.The thermal image showed that the overall temperature distribution of the flap was uniform,the average temperature of the flap was(30.51±0.77)℃,the temperature difference between the flap and the surrounding tissue was 0.5-1.8℃,and the average temperature was(1.17±0.48)℃.The temperature of the skin flap was initially low,reached the lowest at 14 hours after operation,gradually increased at 18 hours after operation,reached the peak at 108 hours after operation,and then the temperature of the skin flap tended to stabilize.4.The incisions of donor and recipient sites healed by first intention,and all patients were followed up 5-18 months,with an average of 11 months.The skin flap was soft and had good blood supply,and the lower limb scar was concealed and the lower limb had good function.No lower limb swelling,pain,numbness,ankle instability,or other complications occurred,and no tumor recurrence and metastasis were found during the followup.Conclusion:1.Compared with the CDU,IRT has certain accuracy in detecting the perforating branch of peroneal artery.2.IRT technology can assist in locating the peroneal artery perforating vessels,and then design personalized flaps to repair oral and maxillofacial defects.It can monitor the blood flow of the flaps in real time after operation,with strong repeatability and high clinical application value. |
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