CLINICAL PRACTICE ARTICLE Journal of the College of Physicians and Surgeons Pakistan 2021, Vol. 31(06): 703-706 703 Flap Monitoring using Thermal Imaging Camera: A Contactless Method Muhammad Jibran Rabbani, Asif Zubair Bhatti and Ahmed Shahzad Department of Burn and Plastic Surgery, Shalamar Hospital, Lahore, Pakistan ABSTRACT Objective: To determine the accuracy of the thermal imaging camera for the detection of vascular insult before the onset of permanent tissue damage. Study Design: Descriptive study. Place and Duration of Study: Department of Burn and Plastic Surgery, from July to December 2019. Methodology: The thermal image was used as an adjunct to clinical assessment in 84 flaps. Both pedicled and free flaps were performed in the study with a frequency of 68 (81%) and 16 (19%), respectively. Flap monitoring was performed regularly for five days by same team of surgeons and nurses. Flap vascularity was assessed by temperature gradient colour coding of thermal image taking the clinical assessment like colour, temperature, capillary refill, as a gold standard. Sensitivity and specificity of the thermal camera were calculated. Results: The age range of patients was from 5 years to 55 years. The diagnostic accuracy of thermal imaging camera was calculated to be 96.43% with a sensitivity of 98.7%, specificity of 75%. The positive predictive value was found to be 97.4%, negative predictive value was 85.7%, the false-negative value was 14.3%, and the false-positive value was 2.6%. Conclusion: Thermal imaging camera is an effective and useful adjunct for clinical assessment, as it is an easy and contactless technique. Key Words: Flir one, Flap monitoring, Thermal imaging camera. How to cite this article: Rabbani MJ, Bhatti AZ, Shahzad A. Flap Monitoring using Thermal Imaging Camera: A Contactless Method. J Coll Physicians Surg Pak 2021; 31(06):703-706. INTRODUCTION Traditionally, flap monitoring in plastic surgery, either pedicled or free, is done subjectively by noting skin colour, skin turgor, temperatureandcapillaryrefill.Physicalfindingsaresubjected toerrors,andthismayleadtodelayinpickingvascularcompro- miseandthusflapfailure. 1 LaboratoryinvestigationslikethepH of blood and flap glucose level monitoring have been intro- duced. 2,3 Under discussion, medical devices are grouped as those which monitor vascularity at flap surface like Doppler flowmetry, near-infra-red, spectroscopy, acoustic Doppler ultra- sound and visible light spectroscopy, and those that check vascular pedicle itself like Duplex ultrasonography, implantable Doppler. 4,5 Recently, infrared thermography has been introduced in medical science for skin temperature moni- toring, 6 detection of inflammation, 7 skin cancer, 8 and breast cancer. 9 Correspondence to: Dr. Muhammad Jibran Rabbani, Department of Burn and Plastic Surgery, Shalamar Hospital, Lahore, Pakistan E-mail: jibranrabbani@hotmail.com ..................................................... Received: July 20, 2020; Revised: October 15, 2020; Accepted: November 15, 2020 DOI: https://doi.org/10.29271/jcpsp.2021.06.703 These infrared thermography devices detect infrared radiation and convert them to images in which temperature values are proportional to pixel values. The obtained image can be taken asamarkerforcutaneousbloodflow.Thistechnologyhasbeen applied to different areas of plastic surgery like burn depth assessment and location of cutaneous perforators. 10-12 Postoperatively, clinical methods of flap monitoring may be difficult in darker skin people. Thermal imaging camera can detect cutaneous perforators as well as an overall cutaneous blood supply. Limited research has been done to determine the accuracy of the thermal imaging camera in the identification of flap viability postoperatively. The aim of this study was to use the utility of thermal imaging camera, as an adjunct to standard clinical methods used for postoperative flap monitoring. METHODOLOGY After taking the ethical approval and informed consent, all patients were enrolled, who underwent flap surgeries, either pedicled or free, in a duration of six months from July to December 2019. Patients with hypo or hyperthermia were excluded as this can produce artefacts taking normal body temperature range of 97 to 99 ⁰F. 13 FLIR ONE® (FLIR Systems, Inc., Wilsonville, Ore.) smartphone thermal imaging camera for