Compromised skin grafts and skin flaps represent a problem involving insufficient oxygen supply to tissue. Plastic surgeons use the grafts and flaps to repair serious injuries, and to close or cover wounds. Skin is taken from one part of the body and used to cover missing skin on another part. There are several types of skin grafts. They include full-thickness grafts, in which all of the skin layers are used, and split-thickness grafts, in which only the top layers and some of the deeper layers are used. There are also pedicle grafts, in which part of the skin remains attached to the donor site. This allows the old blood supply to remain intact while a new blood supply develops.

The problem is what to do when skin grafts appear to be compromised. A freshly applied split-thickness graft receives no oxygen until tiny blood vessels called capillaries can grow into it. Such capillary ingrowth normally takes place over a two to three day period. If this does not happen, it’s not likely that the graft will survive. Hyperbaric oxygen therapy improves the chances that a graft will succeed, both by supplying oxygen and by encouraging capillary growth.

Hyperoxygenation causes an increase in the effectiveness of the blood that reaches the graft through blood vessels. Hyperoxygenation increases the oxygen in the graft bed and wound margins up to 15 fold.

In many instances, HBOT is used only after a skin graft starts to fail. While HBOT can help save failing grafts, it can be even more effective when used before surgery to keep grafts from failing in the first place.

Hyperbaric oxygen also reduces edema and helps to limit the swelling of the graft or flap. Oxygen dissolved in plasma is also readily available to tissues and organs which can decrease damage from reperfusion injury.

HBOT’s effectiveness in supporting skin graft survival is supported by clinical research. The effectiveness of HBOT is shown in grafting, with a salvage rate of 75% for the HBOT group compared to 46% for the controls, with near 100% HBOT salvage when the patient is treated within 72 hours post-operatively.
The use of HBOT for the preparation of a base for skin grafting and the preservation of compromised skin grafts has also been documented as effective.

References:
1. McFarlane RM, Wermuth RE. The use of hyperbaric oxygen to prevent necrosis in experimental pedicle flaps and composite skin grafts. Plast Reconstr Surg 1966;37:422-430.
2. Tan CM, Im MJ, Myers RA, Hoopes JE. Effect of hyperbaric oxygen and hyperbaric air on survival of island skin flaps. Plast Reconstr Surg 1974;73:27-30.
3. Zamboni WA. Applications of hyperbaric oxygen therapy in plastic surgery. In: Oriani G, Marroni A, Wattel F, eds. Handbook on Hyperbaric Oxygen Therapy. New York: Springer-Verlag, 1996.