Hyperbaric Oxygen Therapy for the Compromised Graft or Flap

Abstract

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. 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. 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. 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.

Degree of improvement after hyperbaric oxygen therapy for compromised flap and graft: A case series

“…A current review showed that HBOT is beneficial in several flap settings including dog bite, nasal defect, replantation, or war injury reconstruction [21]. The HBOT should be treated as early as possible particularly within three days after surgery [22].…”

Management of Complications from Skin Cancer Reconstruction

“…By providing supplemental oxygen to hypoxic tissue, HBOT improves fibroblast function and collagen synthesis, leading to normal wound healing. 11 The recent European Committee for Hyperbaric Medicine (ECHM) consensus recommendations give a weak recommendation for HBOT to be used in graft or flap compromise based on a low level of evidence. 12 Interestingly, for patients at high risk of complications (e.g., history of radiation therapy to wound bed and immune compromise), they strongly recommend both pre-and postoperative HBOT, based on a low level of evidence.…”

Hyperbaric oxygenation in transplantology

“…Кроме того, предварительная обработка в условиях ГБО показала положительное влияние на приживаемость трансплантатов органов и лоскутов, используемых в реконструктивной хирургии ран [34,49,50].…”