Compromised Skin Grafts
& Flaps
HBOT is approved for the treatment of compromised skin grafts & flaps.

Hyperbaric Oxygen Therapy for the Compromised
Graft or Flap

Ashish Francis and Richard C. Baynosa*

Division of Plastic Surgery, University of Nevada School of Medicine, Las Vegas, Nevada.

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Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia-reperfusion (IR). Traumatic avulsions and amputated composite tissues—compromised tissue—may fail from crush injury and excessively
large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects.
Recent Advances: Hyperbaric oxygen (HBO) has demonstrated utility in the
salvage of compromised grafts/flaps. It can increase the likelihood and effective size of composite graft survival, improve skin graft outcomes, and enhance flap survival. Mechanisms underlying these beneficial effects include increased oxygenation, improved fibroblast function, neovascularization, and amelioration of IR injury.
Critical Issues: Common strategies for the compromised graft or flap include
local wound care, surgical debridement, and repeated reconstruction. These
modalities are associated with added costs, time, need for reoperation, morbidity, and psychosocial effects. Preservation of the amputated/avulsed tissues minimizes morbidity and maximizes the reconstructive outcome by salvaging the compromised tissue and obviating additional surgery. HBO is often overlooked as a potential tool that can limit these issues.
Future Directions: Animal studies demonstrate a benefit of HBO in the
treatment of compromised tissues. Clinical studies support these findings, but are limited to case reports and series. Further research is needed to provide multicenter prospective clinical studies and cost analyses comparing HBO to other adjunctive therapies in the treatment of compromised grafts/flaps.

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Hyperbaric Therapy for Skin Grafts and Flaps

Mark W. Jones1; Jeffrey S. Cooper2.
Affiliations
1 McLaren Greater Lansing, MSUCOM, 2 University of Nebraska Medical Center
Last Update: July 24, 2023.

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Hyperbaric oxygen therapy has shown promise in salvaging flaps in tissue that has been irradiated or in areas where there is decreased tissue perfusion or hypoxia. Hyperbaric oxygen therapy can potentially increase tissue viability and thus decrease the need for repeat procedures. This activity reviews the indications, contraindications, and techniques involved in utilizing hyperbaric oxygen therapy for skin grafts and flaps and highlights the role of the interprofessional team in the management of patients with skin grafts and flaps.

"Hyperbaric oxygen therapy (HBO2T) is neither necessary nor recommended for the support of normal, uncompromised grafts or flaps. However, in tissue compromised by irradiation or in other cases where there is decreased perfusion or hypoxia, HBO2T has been shown to be extremely useful in flap salvage. Hyperbaric oxygen can help maximize the viability of the compromised tissue thereby reducing the need for regrafting or repeat flap procedures".
Hyperbaric oxygen therapy has many uses. It is indicated for certain soft tissue conditions including compromised and ischemic skin grafts. The treating surgeon and wound care specialist must be aware of these indications in order to make the appropriate and timely referral for hyperbaric therapy. This will add to a better outcome and flap salvage for a certain percentage of patients who would otherwise be victims of failed grafts and poor outcomes.