Automatic detection of perforator vessels using infrared thermography in reconstructive surgery

  • Michael UngerEmail author
  • Miriam Markfort
  • Dirk Halama
  • Claire Chalopin
Original Article



Knowing the location of the blood vessels supplying the skin and subcutaneous tissue is a requirement during the planning of tissue transfer in reconstructive surgery. Commonly used imaging techniques such as computed tomography angiography and indocyanine green angiography expose the patient to radiation or a contrast agent, respectively. Infrared thermal imaging was evaluated with success as a non-invasive alternative. To support the interpretation of thermograms, a method to automatically detect the perforators was developed and evaluated.


A system consisting of a thermal camera, a PC and custom software was developed. The temperature variations of the skin surface were analysed to extract the perforator locations. A study was conducted to assess the performance of the algorithm by comparing the detection results of the algorithm with manually labelled thermal images by two clinicians of the deep inferior epigastric perforator flap of 20 healthy volunteers.


The F measure, precision and recall were used to evaluate the system performance. The median F measure is 0.833, the median precision is 0.80, and the median recall is 0.907.


The results of this study showed that it is possible to automatically and reliably detect the skin perforators in thermograms despite their weak temperature signature. Infrared thermal imaging is a non-invasive and contactless approach suitable for intraoperative use. Combined with a computer-assisted tool for the automatic detection of perforator vessels, it is a relevant alternative intraoperative imaging method to the standard indocyanine green angiography.


Non-invasive imaging Automatic segmentation Operation planning Skin transplant 



The project was funded by the German Federal Ministry of Education and Research (BMWi) in the scope of Zentrales Innovationsprogramm Mittelstand (ZIM) (Grant Number KF 2026723AK4).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2018

Authors and Affiliations

  1. 1.Innovation Center Computer Assisted SurgeryUniversity LeipzigLeipzigGermany
  2. 2.Department of Oral, Maxillofacial and Plastic Facial SurgeryUniversity Hospital LeipzigLeipzigGermany

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