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How Hyperbaric Oxygen Therapy Intervenes for Compromised Grafts and Flaps

Updated: Nov 26, 2023




Grafts and flaps are rehabilitative measures that are applied to the body after various destructive phenomena that involve a deviation from the regular state of skin and body tissue. The aforementioned are the most common form of reconstructive surgery. Some of the phenomena that warrant reconstructive measures include burns, cuts, amputations, trauma, tumors, and crush injuries, among others. Grafts and flaps form part of the numerous measures that are encompassed in surgical wound management. Most of the wounds on which grafts and flaps are used are surgical and mostly non-healing in nature. Some of the probable causes of compromised skin grafts and flaps include radiation injury, type II diabetes (Diabetes mellitus), advanced age, prior infection, poor nutrition, smoking, and intake of too much alcohol and other drugs. Also, weak immunity, excessive use of steroids, and jeopardized local blood circulation are likely to lead to compromise of the grafts and flaps. Graft and flap failure occurs quite often with most instances taking place 1-2 days after reconstruction has taken place.

Hyperbaric oxygen therapy (HBOT) plays a key role in ensuring that grafts and flaps are effective and they merge well with the underlying tissue. HBOT is mostly used on tissue that is compromised and is not needed for uncompromised grafts and flaps. However, it is also used by some individuals before the correction exercises to boost healing as well as reduce the chances of compromise. HBOT is used in instances where the underlying tissue on which the grafts and flaps are being placed is hypoxic and has flawed perfusion. In this case, tissue oxygenation aids in increasing the viability and success of the rehabilitation processes. Ample oxygen supply on the transplanted tissue boosts vascularization and increases capillary growth. Also, I results in proper connection of capillaries for the graft/flap and host. Increased vascularity implies a constant supply of oxygen to the healing tissues. Swelling and edema which result from insufficient oxygen supply are handled by the application of hyperbaric oxygen (HBO) as well. Also, with increased tissue oxygenation, there is increased production of white blood cells to wade off probable infections that are by disease-causing microorganisms. Increased oxygen supply also boosts fibroblast function and collagen synthesis which are key in the proper healing of wounds in context. This also saves on the huge financial implications associated with redoing the processes and associated rehabilitation and therapy activity. Regrafting and repeated flap procedures take a toll on those involved, both financially, physically, and psychologically. For more efficiency, HBOT ought to be used on the grafts and flaps as soon as signs of compromise are noted. Ultimately, HBOT improves the outcome of graft and flap processes.

References

Jenwitheesuk, Kamonwan, et al. “Degree of improvement after hyperbaric oxygen therapy for compromised flap and graft: A case series.” Biomedical Research, vol. 29, no. 16, 18 Jan. 2018, pp. 3177–3181, https://doi.org/10.4066/biomedicalresearch.29-18-663.

Phillips, Joan C. “Understanding hyperbaric oxygen therapy and its use in the treatment of compromised skin grafts and flaps.” Plastic Surgical Nursing, vol. 25, no. 2, 14 Feb. 2005, pp. 72–80, https://doi.org/10.1097/00006527-200504000-00006.


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