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Compromised Grafts and Flaps

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Hyperbaric oxygen is only indicated according to the UHMS in skin grafts or flaps which are showing signs of compromise. This may be due to radiation damage, areas of decreased perfusion or hypoxia. It is not a necessary adjunct in routine cases or for normally healing tissue.

Increasing oxygen tension in the tissue at risk leads to

  • Reduction in hypoxic insult to tissue through reactive oxygen species.
  • Reduction in oedema by restoring cell membrane active transport
  • Closure of AV shunts around areas of poor perfusion
  • Improved microcirculation within capillaries
  • Enhanced fibroblast function and collagen synthesis
  • Neovascularisation

There are multiple animal studies which have shown improved outcomes in flaps on rats.

In particular, Qirinia and Viidik conducted research on the outcomes of incisional and ischaemic flaps in young and old rats and the impact of additional HBO. They showed that in older rats flaps had higher levels of ischaemia. The use of HBO reversed this finding. The greatest difference in healing was seen in the old rats, but there was also enhanced healing seen in the younger rats.

Perrins et al completed an RCT in 1967 on 48 patients with split skin grafts. The 24 patients that received HBO saw a significant increase in graft survival (64%) vs controls (17%).

It must be borne in mind that HBO is best used as an adjunct to best standard clinical care.

Treatment entails up to 40 sessions of HBO over an 8 week period subject to response to treatment. If surgery is planned then this may be split into pre and post operative treatment.

References

The Royal College of Surgeons of Edinburgh

Diploma in Remote and Offshore Medicine

Details found at

http://www.rcsed.ac.uk/education/academic-programmes/remote-and-offshore-medicine/rom-cpd.aspx (Accessed July 2015)

 

Qirinia(1996)

Qirinia A, Vlidik A

“The impact of ischemia on wound healing is increased in old age but can be countered by hyperbaric oxygen therapy.”

Mech Ageing Dev.

1996 Oct 25;91(2):131-44.

 

Perrins(1967)

Perrins DJ

“Influence of hyperbaric oxygen on the survival of split skin grafts.”

Lancet

1967 Apr 22;1(7495):868-71

 

 

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