The effect of hyperbaric oxygen on compromised grafts and flaps

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, hyperbaric oxygen (HBO2) therapy 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 HBO2 therapy for compromised grafts and flaps. The literature demonstrates the benefit of adjunctive HBO2 therapy for multiple types of grafts and flaps with various etiologies of compromise. HBO2 therapy 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.