Role of Hyperbaric Oxygen Therapy in Maximizing Flap Survival in Compromised Free Flaps: A Case Report

Hyperbaric oxygen therapy (HBOT) has shown potential in salvaging compromised flaps, although its application has primarily been focused on local flaps rather than free flaps.

In this case report, we present the successful use of HBOT in a 76-year-old man who underwent free flap reconstruction for calcaneal osteomyelitis. Despite undergoing 2 reoperations on the second and third days post reconstruction, no thrombosis was observed at the anastomotic site. Following the second reoperation, HBOT was promptly initiated and continued for a total of 9 sessions. Notably, after the sixth HBOT session, fresh bleeding occurred upon flap puncture. Eventually, the flap developed epidermal necrosis, which was conservatively treated.

It is crucial to first rule out mechanical causes of compromised free flaps through surgical exploration, with HBOT serving as an adjunctive rather than a primary treatment option--even considered as the last resort. Nevertheless, in cases where mechanical causes have been ruled out, HBOT may significantly enhance flap survival rates in compromised free flaps.