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OBJECTIVE: To determine the diagnostic accuracy of smartphone thermal imaging for preoperative perforator mapping in perforator-based flaps, taking visual inspection as gold standard. METHODOLOGY: It was a cross-validation study conducted at the Department of Plastic Surgery, Dr. Ruth K. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. All adult patients aged 18 to 40 years of either gender undergoing perforator flap surgery were included. Each patient followed the same treatment regimen, which involved the preoperative identification of the perforator location using the FLIR One camera. Subsequently, confirmation was achieved during the surgical procedure through visual inspection. A two-by two table was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. RESULTS: The mean age of the patients was 30.10±6.87 years, ranging from 18 to 40 years. Most of the patients were males (58.7%), and 41.3% were females. Almost 80.4% were pedicle flaps, and 19.6% were free flaps. The accuracy of thermal imaging was found to be 83.2%, with a sensitivity of 84.3%, a specificity of 80%, a PPV of 92.9%, and a NPV of 62.2%, respectively. CONCLUSION: Smartphone-based thermal imaging is useful for the diagnosis of perforators and has high sensitivity and specificity.
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BACKGROUND: Split-thickness skin grafting (STSG) is a widely employed technique for repairing wounds, such as ulcers, trauma, or in reconstructive surgeries. The objective was to compare the efficacy of different dressing materials for healing donor-site wounds after split-thickness skin grafting. METHODS: A single center, randomized controlled trial was conducted at the Department of Plastic Surgery, Civil Hospital Karachi, Pakistan, over a period of six months. The study included patients aged 18 years and above, of both genders, who underwent single donor-site wounds after split-skin grafting with a surface area larger than 10 cm². The eligible patients were randomly divided into six groups: Film, Alginate, Gauze, Hydrofiber, Hydrocolloid, and Silicone. Pain, itching, scarring, complications, and patient satisfaction were evaluated after 12 weeks using standardized assessment scales. RESULTS: The median time to complete wound healing and re-epithelialization varied among the different dressing groups, with hydrofiber and silicone dressings demonstrating the shortest healing time. Statistical analysis revealed a significant difference in the median time to complete wound healing among the dressing groups (p-value=0.019). However, no significant differences were observed in pain, itching, scarring (POSAS observer and patient), or patient satisfaction among the different dressings (p-value>0.05). CONCLUSIONS: Although the dressing type did not significantly affect pain, itching, scarring, or patient satisfaction, variations were observed in the time to complete wound healing. These findings contribute to the selection of appropriate donor site dressings for optimizing outcomes in split-skin grafting procedures.