Hyperbaric Oxygen Therapy for the Compromised Graft or Flap.

Area of Science:

• Reconstructive surgery
• Tissue engineering
• Hyperbaric medicine

Background:

• Tissue grafts and flaps are crucial for wound reconstruction but are prone to failure from factors like poor wound beds, radiation, and ischemia-reperfusion (IR) injury.
• Complications lead to tissue loss, additional surgeries, increased costs, and negative patient psychosocial effects.
• Hyperbaric oxygen (HBO) therapy has emerged as a potential adjunct for salvaging compromised tissues.

Purpose of the Study:

• To review the utility of HBO in improving outcomes for compromised tissue grafts and flaps.
• To discuss the mechanisms by which HBO exerts its beneficial effects.
• To highlight critical issues with current management strategies and propose future research directions.

Main Methods:

• Review of existing literature on HBO therapy for compromised grafts and flaps.
• Analysis of proposed mechanisms of action, including increased oxygenation and neovascularization.
• Evaluation of clinical evidence, primarily case reports and series, and animal studies.

Main Results:

• HBO therapy has demonstrated potential in increasing graft and flap survival, improving outcomes for skin grafts, and enhancing overall flap viability.
• Key mechanisms include enhanced tissue oxygenation, improved fibroblast function, promotion of neovascularization, and mitigation of ischemia-reperfusion injury.
• Animal studies show benefits, and clinical case studies support HBO's utility, though large-scale trials are lacking.

Conclusions:

• HBO therapy offers a promising, yet often overlooked, adjunctive treatment for compromised tissue grafts and flaps, potentially reducing failure rates and associated morbidities.
• Current clinical evidence is largely based on case reports and series, necessitating further rigorous investigation.
• Future research should focus on multicenter prospective clinical trials and cost-effectiveness analyses to establish HBO's role in reconstructive surgery.