Remote monitoring of digital flaps using Pixacare: A prospective implementation study (Chevalier et al. 2026)

Photographic remote monitoring of digital flaps through the Pixacare application shows strong inter-observer agreement (Kappa = 0.64) and a patient satisfaction score of 4.63/5, supporting its value in spacing out postoperative in-person consultations in hand surgery.

Publication

Study published in Annales de Chirurgie Plastique Esthétique (Elsevier), May 2026, Volume 71, Issue 3, pages 250–256 — access the publication. Findings derived from a doctoral thesis in medicine defended on October 20, 2023 at the University of Lille (Henri Warembourg Faculty of Medicine).

Objectives

The study addresses two complementary objectives:

• Primary objective: to assess the reliability and reproducibility of photographic remote monitoring with the Pixacare tool for postoperative follow-up of digital flaps, by analyzing inter-observer agreement.
• Secondary objective: to evaluate the feasibility of outpatient follow-up through the same application, by examining adherence among patients and community nursing staff.

Materials and Methods

A descriptive, prospective, single-center study conducted at SOS Main Lesquin (France) from January 1 to July 1, 2023, including 27 patients managed as outpatients following pedicled digital flap reconstruction.

The protocol relied on the following elements:

• A personal QR code issued to each patient after surgery, granting access to a secure Pixacare record
• Weekly photographic transmission of the flap by community nurses through the application
• Analysis of sequences by 3 observers, classified into two categories: normal healing or complication
• Reliability measured using the Fleiss Kappa coefficient
• Patient satisfaction rated on a 5-point scale
• Prior ethical approval obtained before inclusion

Results

A total of 76 photographic sequences were collected via the Pixacare application across the 27 patients included. Key findings are:

• Strong inter-observer agreement: Fleiss Kappa = 0.64 (95% CI [0.51; 0.77]; p < 0.001)
• Mean patient satisfaction: 4.63 / 5
• Satisfaction significantly higher among non-smokers compared to smokers
• Paramedical adherence is identified as a key area for improvement before large-scale deployment

These results confirm that photographic analysis through Pixacare is reliable for the clinical follow-up of digital flaps and support the view that this tool can space out in-person postoperative consultations, particularly for patients located far from specialized hand surgery centers.

Keywords

Digital flap, remote monitoring, hand surgery, postoperative follow-up, telemedicine, medical photography