Compromised Grafts and Flaps

Compromised Grafts and Flaps

Hyperbaric oxygen therapy (HBO2T) is neither necessary nor recommended for the support of normal, uncompromised grafts or flaps. However, in tissue compromised by irradiation or in other cases where there is decreased perfusion or hypoxia, HBO2T has been shown to be extremely useful in flap salvage. Hyperbaric oxygen can help maximize the viability of the compromised tissue thereby reducing the need for regrafting or repeat flap procedures. The criteria for selecting the proper patients that are likely to benefit from adjunctive hyperbaric oxygen for graft or flap compromise is crucial for a successful outcome. Identification of the underlying cause for graft or flap compromise can assist in determining the proper clinical management and use of hyperbaric oxygen therapy. A number of studies have shown the efficacy of HBO2T on enhancement of flap and graft survival in a variety of experimental and clinical situations.

 

2012 Jul-Aug;39(4):857-65.

The effect of hyperbaric oxygen on compromised grafts and flaps.

Abstract

The use of grafts and flaps serves as an integral tool in the armamentarium of the reconstructive surgeon. Proper planning and surgical judgment are critical in the ultimate success of these procedures. However, there are situations when grafts and/or flaps can become compromised and require urgent intervention for salvage. These instances can include irradiated or otherwise hypoxic wound beds, excessively large harvested grafts, random flap ischemia, venous or arterial insufficiency and ischemia-reperfusion injury. Alternatively, compromised grafts and flaps can be inadvertently created secondary to trauma. It is in these types of cases that hyperbaric oxygen therapy (HBO2T) can serve as a useful adjunct in the salvage of compromised flaps and grafts. This review outlines the extensive basic science and clinical evidence available in support of the use of HBO2T for compromised grafts and flaps. The literature demonstrates the benefit of adjunctive HBO2T for multiple types of grafts and flaps with various etiologies of compromise. HBO2T can enhance graft and flap survival by several methods including decreasing the hypoxic insult, enhancing fibroblast function and collagen synthesis, stimulating angiogenesis and inhibiting ischemia-reperfusion injury. The expedient initiation of hyperbaric oxygen therapy as soon as flap or graft compromise is identified maximizes tissue viability and ultimately graft/flap salvage.

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Additional indications for hyperbaric oxygen therapy may be discussed with your doctor and the Hyperbaric Medicine Team. Hyperbaric oxygen  therapy is usually used as an adjunct to additional care the patient is receiving. Additional treatments may also include antibiotic therapy, nutritional support, and surgical procedures, if indicated.  Our Hyperbaric Medicine Team will work closely with your physician(s) to coordinate any additional care needed.


Contact the Department of Hyperbaric Medicine at MemorialCare, Long Beach Medical Center for more information.

 

MemorialCare, Long Beach Medical Center
Department of Hyperbaric Medicine
2801 Atlantic Avenue
Long Beach, California 90806


Telephone: (562) 933-6960

 Fax: (562) 933-6060