The Impact of a Selected Surgical Procedure on Skin Blood Perfusion of the Abdominal Wall Evaluated by Dynamic Infrared Thermography (DIRT)

Introduction Wound healing problems after surgery are a stressful experience for patients. Wound dressing changes are often on a daily basis and can cause considerable discomfort to the patient as these are often painful. Wound healing problems can lead to complications like wound infection, hernia formation, wound rupture or even tissue necrosis. These complications are often associated with prolonged hospital stays and reoperations and cause an economic burden to the hospital health budget. It is generally accepted that adequate blood perfusion of the wound edges is required for optimal wound healing. Greater understanding of the impact of a surgical procedure on skin perfusion may help to reduce postoperative wound healing problems. Such will have great clinical relevance.

Aim Can postoperative wound complications involving the abdominal wall be explained by changes in skin blood perfusion?

Main results from the literature study In surgery, knowledge on the vascular anatomy is applied in order to place incisions in such a manner that a good approach is combined with minimal damage to the vascular anatomy. Knowledge on vascular anatomy does not provide exact information on how skin perfusion alters after surgery. The invasive method indocyanine green fluorescence-agiography (ICG-FA) can be used to evaluate intraoperatively the effect of an abdominoplasty on skin perfusion. However, animal studies in flap surgery have clearly shown that tissue perfusion is a dynamic process. Using dynamic infrared thermography (DIRT) in a clinical setting revealed that flap perfusion is a dynamic process that takes place over days during the postoperative phase. DIRT is a non-invasive technique that relies on measuring skin surface temperatures. Studies have shown that there is a close correlation between skin temperature and skin perfusion. DIRT has been shown to be a good alternative to ICF-FA to visualize skin perfusion.

Purpose of the study The purpose of the study is to analyze the impact of a surgical procedure on skin perfusion of the abdominal wall in order to increase our understanding on how postoperative wound healing problems can be avoided.

Study population The study population will include patients that are undergoing one of the following operations; a) abdominoplasty, b) breast reconstruction after breast cancer with a free flap from the lower abdomen and c) endovascular stenting of the abdominal aorta for aneurysm. These surgical procedures are frequently performed procedures at the University Hospital of North Norway (UNN). Based on the vascular anatomy of the abdominal wall, each procedure will have an impact on the skin perfusion of the abdominal wall.