الفهرس 
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Abstract
In this study, we evaluate the versatility of smart- phone thermal imaging technology as a valuable pre and intraoperative modality in different stages of perforator flap surgery aiming to minimize the complications and achieve the best postoperative outcome. Thermography was performed preoperatively in 20 patients awaiting DIEP flap reconstruction and intraoperatively in 20 perforator flaps in 20 patients at different surgical stages in three different ways to identify the most dominant perforator: first, by measuring the surface temperature of the skin; second, by using the dynamic infrared thermography technique; and third, by assessing the perfusion pattern when the flap was supplied by each perforator separately. Thermography was used to help in discarding the least perfused area of the flap. After microvascular anastomosis, the flap reheating pattern was evaluated. In the preoperative study: All the hottest hotspots marked using thermography in all patients were found lying in the same zone of the dominant perforator in CTA. Range of distance in the medial-lateral direction was from 0 to 57.44 mm and in the supero-inferior direction was from 1.27 to 42.5 mm. In the intraoperative study: Seventeen free and three pedicled perforator flaps were included. Intraoperatively, each of the selected perforators had a corresponding hotspot. The perforator with the hottest hotpot, best rewarming, and provision of best flap perfusion on thermography was found clinically dominant. After microvascular anastomosis in free flaps, rapid rewarming was recorded in 15 cases. In two deep inferior epigastric perforator flaps, no rapid rewarming was observed. The pedicle was kinked in one case and there was a venous insufficiency in another case that required a cephalic turndown. All flaps showed good perfusion on thermography after inset. Smartphone thermography has proven to be a valuable, cheap, rapidly employed and objective tool not only for the design of perforator flaps, but also for management of the flap intraoperatively in each surgical step. This non-invasive technique provides the surgeon with real-time visualization of the most suitable perforator and allows continuous monitoring of the flap perfusion in different stages, before and after flap harvest, helping to achieve the best possible surgical outcome.