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.
