Abstract

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 that hyperbaric oxygen therapy (HBO2T) 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 HBO2T for compromised grafts and flaps. The literature demonstrates the benefit of adjunctive HBO2T for multiple types of grafts and flaps with various etiologies of compromise. HBO2T 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.

Authors

Baynosa RC, Zamboni WA

Institution

University of Nevada School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, USA. rbaynosa@medicine.nevada.edu

Source

Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc 39:4 pg 857-65

MeSH

Animals
Graft Rejection
Graft Survival
Humans
Hyperbaric Oxygenation
Models, Animal
Patient Selection
Rabbits
Radiation Injuries
Rats
Surgical Flaps
Swine

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22908842