Hyperbaric Oxygen Therapy for SKIN GRAFTS AND FLAPS

SKIN GRAFTS AND FLAPS (COMPROMISED)

Hyperbaric oxygen (HBO₂) therapy is not necessary nor is it recommended for the support of normal, uncompromised skin grafts or flaps. However, following preoperative or postoperative irradiation or in other cases where there is decreased microcirculation or hypoxia, HBO₂ has been shown to be extremely useful in preserving these compromised grafts and flaps. HBO₂ is also effective in promoting capillary proliferation and granulation to prepare a surgical site. This preparation is essential for patients who require grafts or flaps to cover areas where compromised microcirculation or hypoxia contributes to questionable viability of the transplanted tissue.

RATIONALE: A variety of grafts and flaps have been investigated in animal and human studies. The literature clearly shows the efficacy of HBO₂ with respect to enhancement of wound healing and skin graft and flap survival. Of importance is that different types of flaps have been analyzed in these studies including free skin grafts, pedicle flaps, random flaps, irradiated wounds and flaps, composite grafts, as well as axial pattern flaps. Although the blood supplies are very different in these flaps, a key factor to flap necrosis is tissue hypoxia. The results indicate that viability of flaps can be enhanced by HBO₂ through a reduction of the hypoxic insult. Other mechanisms of action, whereby, enhances flap survival include the enhancement of fibroblasts and collagen synthesis, neovascularity, and the possibility of closing off arteriovenous shunts. To be maximally effective, HBO₂ therapy should be started as soon as there is any doubt as to the viability of the flap.

Source: Hyperbaric Oxygen Therapy: A Committee Report. Undersea and Hyperbaric Medical Society. 1996 Revision

Approved Indications

Chico Hyperbaric Center
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