To evaluate the efficacy of infrared thermographic camera imaging as an additional adjunct to the already existing clinical methods, in microvascular free flap monitoring following head and neck reconstruction.

A diagnostic test designed to include cases of hospitalized patients, who underwent free flap reconstructions following Head and neck resections, over a period of 2 years. Patients were evaluated with clinical/Doppler methods and thermographic camera hourly for 24 h, every 2 h for the next 24 h, and then every 3 h until discharge. The gold standard was visualization of thrombus or vascular obstruction during surgical reintervention. A second generation FLIR (Wilsonville, OR) infrared camera compatible with any smart phone was used (temperature range: − 20–120 °C, error is 0.1 °C).

All flaps were subjected to thermographic imaging with a thermographic camera and clinical evaluation (Doppler, flap color, capillary refill, warmth and pulse) in 24 patients. Three cases had postoperative vascular obstruction which were picked up early by the thermographic camera (two venous and one arterial). The thermal imaging camera allows early identification of vascular obstruction as early as 2 h before the clinical method.

Utilizing a thermographic camera as an additional adjunct to the already existing clinical methods of observation and doppler to detect early vascular obstruction, can significantly reduce obstruction to detection and early intervention time by several hours. This method definitely proves to be cost effective and as an additional adjunct in early detection of vascular obstruction and timely intervention to salvage the flap.