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Francis A, Baynosa RC, et al.
Advances in wound care. Date of publication 2017 Jan 1;volume 6(1):23-32.
1. Adv Wound Care (New Rochelle). 2017 Jan 1;6(1):23-32. doi: 10.1089/wound.2016.0707. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap. Francis A(1), Baynosa RC(1). Author information: (1)Division of Plastic Surgery, University of Nevada School of Medicine , Las Vegas, Nevada. 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. DOI: 10.1089/wound.2016.0707 PMCID: PMC5220535 PMID: 28116225 Conflict of interest statement: Author Disclosure and Ghostwriting No competing financial interests exist. The content of this article was expressly written by the authors listed. No ghostwriters were used to write this article.
Appears in following Topics:
Compromised Skin Grafts and Flaps
Compromised Skin Grafts and Flaps