Hyperbaric Oxygen Treatment for Compromised Skin Flaps
Compromised Skin Flaps; Benefits from Hyperbaric Oxygen:
- Skin grafts immediately become ischemic or hypoxic on harvest. The recipient bed must be healthy enough to accept and nourish a graft. The goal is to identify wounds that have failed usual therapy, and flap coverage that can respond locally to HBOT.
- Indications for adjunctive HBOT for flaps and grafts include preparing a granulating base in selected patients with compromised wounds (diabetic ulcer, venous stasis ulcer, arterial insufficiency ulcer) or flaps, and patients at high risk due to previous failures.
- Oxygen availability is critical to skin grafting success. HBOT increases tissue oxygen levels in hypoxic and ischemic wounds. HBOT stimulates formation of blood vessels and granulation tissue, and prepares the recipient bed for grafts or flaps.
- In some cases, HBOT will be enough to make skin grafting unnecessary or reduce re-grafting and repeat flap procedures.
- HBOT’s effectiveness in supporting skin graft survival is supported by clinical research. The effectiveness of HBOT is shown in grafting, with a salvage rate of 75% for the HBOT group compared to 46% for the controls, with near 100% HBOT salvage when the patient is treated within 72 hours post-operatively.
(Zamboni WA. Applications of hyperbaric oxygen therapy in plastic surgery. In: Oriani G, Marroni A, Wattel F, eds. Handbook on Hyperbaric Oxygen Therapy. New York: Springer-Verlag, 1996.)
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