The Use of Infrared Thermal Imaging for Real-Time Flap Perfusion in Revision Palatoplasty with Buccinator Myomucosal Flaps

Abstract

Background

Infrared thermal imaging (IRTI) provides real-time visualization of tissue perfusion and may improve outcomes in flap-based reconstructive procedures. This study evaluated the impact of IRTI on complication rates following revision palatoplasty using a buccinator myomucosal flap (BMMF).

Methods

A retrospective cohort study was performed on patients who underwent revision palatoplasty with BMMF between 2021 and 2024 at a single institution. Postoperative outcomes, including partial flap loss, dehiscence, and fistula formation, were compared between cases in which IRTI was utilized and those evaluated solely by traditional clinical assessment. A brief expected-cost analysis was performed.

Results

Among 80 cases, 20 (25%) utilized IRTI for intraoperative flap evaluation and 60 (75%) did not. The overall complication rate was significantly lower in the IRTI group compared to the non-IRTI group (10% vs. 35%; p = .032). Partial flap loss occurred in 5.0% of IRTI cases versus 18.3% of non-IRTI cases (p = .139). No major complications occurred in the IRTI cohort, whereas 33.3% (7/21) of complications in the non-IRTI group required operative intervention. With conservative estimates for revision surgery, this corresponded to approximately $10,640 in savings per patient.

Conclusion

Intraoperative use of IRTI during revision palatoplasty with BMMF was associated with significantly lower complication rates and reduced severity of complications. By providing real-time, objective information about flap perfusion, IRTI may enhance intraoperative decision-making, improve flap viability, and reduce postoperative morbidity. These findings support IRTI as a cost-effective and noninvasive adjunct to standard clinical assessment in reconstructive surgery.