Skin grafts and compromised skin flaps always involve an insufficient oxygen supply to the tissue. Plastic surgeons use grafts and flaps to repair serious damage, and to close and cover wounds. Once a graft is in place, the bed and the edges are the only areas that provide blood and oxygen. HBOT maximizes oxygenation, reduces edema, and encourages new blood vessel growth.
HBOT increases the oxygen in the graft bed and wound margins up to 1500%. The hyperoxygenation increases the blood and plasma that reaches the graft and marked tissue salvage is possible. Increased macrophage* migration, proline** synthesis and blood vessel growth occurs.
*a type of phagocyte that eats pathogens and cellular debris
**a DNA-encoded amino acid synthesized within the human body involved in collagen production
HBOT treats the hypoxia, post-operative swelling, and ischemia of grafts and flaps. The use of HBOT for the preparation of a base for skin grafting and the preservation of compromised skin grafts has been shown as effective.
Approved use of HBOT is limited to those cases where a skin graft begins to fail. Skin grafts are frequently used for burn patients. There are several types of skin grafts. Full-thickness grafts involve using all of the skin layers, whereas split-thickness grafts use the top layers and some of the deeper layers. There are also pedicle grafts where part of the skin remains attached to the donor site.
Many skin grafts do not “take” because the capillaries do not have a chance to grow into the graft to nourish it. It usually takes capillaries two or three days to grow in—if that doesn’t happen it is unlikely that the graft will survive. HBOT improves the chances that the graft will take, by supplying oxygen directly to the graft. Pioneering reconstruction surgeon, Dr. Isadore Boerema, used HBOT for skin grafts.