The Effect of Hyperbaric Oxygen Therapy on Composite Graft Survival

Abstract

Auricular composite grafts are a useful reconstructive option, particularly for nasal reconstruction. This study evaluates the effect of hyperbaric oxygen (HBO) therapy on auricular composite graft survival in rabbits. Circular chondrocutaneous composite grafts of 0.5, 1, or 2 cm in diameter were resected from the ears of rabbits. The grafts were sutured back into position. Half the rabbits in each group received HBO postoperatively, consisting of 90 minutes at 2.4 atm. Rabbits received 7 treatments in 5 days. Control rabbits did not receive HBO. On day 21 the percentage area of graft survival was calculated from gross and histologic examination. Two-centimeter grafts treated with HBO (n = 8) had a mean graft survival rate of 85.8 +/- 15.7% compared with a survival rate of 51.31 +/- 38.5% for the control group (n = 8; P = 0.0478). There was no such benefit in smaller grafts. HBO could prove clinically useful for larger composite grafts.

Composite Grafting for Pediatric Fingertip Injuries

“…There have been many described strategies to optimize take of composite grafts in various parts of the body, including post-operative cooling [13], hyperbaric oxygen therapy [17], pharmacologic agents [1,10], and burying the part in a subcutaneous pocket [2,9], among others. Other authors have proposed using a composite graft from the hypothenar region for reconstruction of fingertip injuries [14], and others have advocated a moist-exposed dressing to maximize composite graft take [23].…”

The effect of carbon dioxide therapy on composite graft survival

“…Therapeutic indications of CO 2 therapy include vascular, cardiac, metabolic and rheumatic diseases, cellulite, chronic wounds, localized adiposities, migraine headaches. It is used, as well, in radiology to guided catheters placement and in laparoscopic surgeries for visualization of the surgical field [3][4][5][6][8][9][10][11][12][13][14][15][16][17] . CO 2 therapy is safe, with low cost, no toxicity or side effects [3][4][5]12,17 .…”

Successful Bilateral Composite Ear Reattachment

“…14,15 Survival advantages in the rabbit model have also been reported by multiple authors. 16–19 The anecdotal clinical evidence supporting the use of HBO in composite grafts has also been reported by multiple authors. 20–22 In a single ear near-complete amputation and reattachment reported by Komorowska-Timek and Hardesty, 22 their patient’s injury included 2 small skin bridges and their clinical protocol included keeping the patient extra warm in a “hot” room for the first 72 hours postoperatively, presumably to maximize vasodilation in the small soft-tissue bridge attachments that remained, unlike our use of cooling the reattached ear parts which had been completely severed.…”