Hi Sarah,

Thanks for your question - below is an excerpt of the topic Compromised Skin Grafts and Flaps, with information on HBOT Criteria and Treatment protocol.

The HBOT Knowledge Base > Outreach tab also has a flyer that can be shared with referring providers, with information on HBOT criteria and treatment that will be useful for determining timing.

HBOT Criteria:

• Surgical referral with current diagnosis and documentation of skin graft or flap compromise (e.g., random pattern ischemia, pain, coolness or a bluish/purple hue of the cutaneous portion of flap)
• Absence of surgically correctable cause of decreased perfusion to flap or skin graft (e.g. skin flaps created by trauma with inadequate perfusion due to crush injury, large random flaps that do not follow the classic 3:1 length-to-width ratio, ischemia-reperfusion injuries, etc)
• Initiation of first HBO session within 24 hours of the initial limb/ digit replantation/ revascularization. This is generally considered a hyperbaric emergency and due consideration for urgent (within one to a few hours) initial treatment in a hyperbaric chamber.
• Postoperative edema and congestion, in the absence of obvious surgically correctable causes of ischemia or congestion
• Postoperative concerns regarding viability of the replanted part. A reference to a verbal conversation with the surgeon is adequate documentation.

Of note:

• Hyperbaric Oxygen therapy should be started as soon as signs of flap or graft compromise appear.
• In an acutely failing flap, up to 3 treatments in the first 24 hours is recommended.
• After the first 24 hours, twice daily treatments are recommended.

Topics:

• https://woundreference.com/app/topic?id=compromised-skin-flaps-grafts
• https://woundreference.com/app/topic?id=comp-graft-flap-marketing