Cutaneous perfusion dynamics of the lower abdomen in healthy normal weight, overweight and obese women: methods development using infrared thermography with applications for future wound management after caesarean section

Background: Evidence has shown an association between obesity and an increased risk of wound infection after caesarean section. This study was designed to examine if abdominal subcutaneous adiposity impacts upon cutaneous perfusion dynamics. Methods: Mild cool challenge, followed by real-time video thermography, was developed to map the appearance of abdominal ‘hot spots’. Correspondence of marked ‘spots’ with audible Doppler and colour and power Doppler ultrasound was performed. Results: 60 healthy, afebrile, women (20–68 years; BMI 18.5–44 kg/m2) were recruited. Hot spot appearance consistently corresponded with audible Doppler sounds. Colour and power Doppler ultrasound revealed vessels at depths of 3–22 mm. No statistically significant interactions for BMI, abdominal circumference or environmental parameters were observed for hot spot count. The temperature of cold stimulus was significant for effects on spot count, but only for the first minute (p = 0.001). Thereafter, effects on spot numbers were not significant. Conclusions: Cutaneous ‘perforator’ mapping of the abdomen (via hot spot appearance) in healthy women, as a potential and future method for risk of perfusion-dependent wound healing complications, reveals that bedside mapping of skin perfusion is feasible over a short interval. Hot spot number was not influenced by BMI or indicators of central fat distribution (abdominal circumference) indicating variability in an individual’s vascular anatomy. This study provides the underpinning methodology for personalised perfusion assessment after incisional surgery which may be a more reliable indicator of potential healing complications than body habitus as is currently the norm.