Compromised Skin Grafts and Flaps

Skin grafts and compromised skin flaps represent a classical problem involving insufficient oxygen supply to tissue. Plastic surgeons use the grafts and flaps to repair serious damage, and to close or cover wounds. Skin is taken from one part of the patients, body and used to cover a break in the 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 several 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 not to be taking. A freshly applied split-thickness graft receives no oxygen until tiny blood vessels called capillaries can penetrate 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. HBOT improves the chances that a graft will take, both by supplying oxygen and by encouraging quick capillary growth.

Providing hyperoxygenation increases the oxygen tension in the graft bed and wound margins up to 1500 percent. In turn, the hyperoxygenation causes a marked increase in the effectiveness of the blood or plasma that reaches the graft through compromised blood vessels. The volume of tissue that derives sufficient oxygen from a single damaged blood vessel increases 16 fold, and marked tissue salvage results.

Lack of oxygen tends to be less of a problem with full-thickness and pedicle grafts, since these grafts have their own supply of capillaries, Even so, it still takes time for good blood flow to become established through these typed of grafts, Therefore, full-thickness and pedicle grafts also respond to HBOT. I the case of pedicle graft, it is important that HBOT be employed before what little circulation this is present develops blood clots.

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.

Hyperbarics also offer strategies for reducing edema. The edema reduction effect, induced by the relative spasm of a precapillary arteriolar sphincter, helps to limit the swelling of the graft or flap. The high oxygen tension achievable with HBOT induce large oxygen neovascularization. Among other things, oxygen dissolved in plasma is readily available to tissues and organs limiting damage from reperfusion injury.

HBOT's effectiveness in aiding skin graft survival us supported by research. The effectiveness of HBOT is shown in grafting and in reimplantation of limbs, with a salvage rate of 75% for the HBOT group compared to 46% for the controls, with 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 been well documented as effective.