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Hyperbaric Oxygen Therapy: Enhancing Survival of Failing Grafts and Flaps

Updated: Mar 23

In reconstructive surgery, grafts and flaps are essential techniques used to cover defects resulting from injuries, surgeries, or diseases. Despite advances in surgical techniques, the failure of grafts and flaps remains a significant concern, often due to inadequate blood supply, infection, or edema. Hyperbaric Oxygen Therapy (HBOT) has emerged as a valuable adjunctive treatment to enhance the survival of these critical surgical repairs. This article explores the role of HBOT in improving the outcomes for failing grafts and flaps, supported by scientific evidence and clinical findings.

Understanding Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy involves the administration of 100% oxygen at pressures greater than atmospheric pressure in a specialized chamber. This process increases the oxygen content in the blood and tissues, which can accelerate healing, reduce inflammation, and fight infection. By delivering a higher concentration of oxygen to compromised areas, HBOT can play a crucial role in salvaging failing grafts and flaps.

The Benefits of HBOT for Grafts and Flaps

  1. Improved Oxygenation: The primary benefit of HBOT is its ability to significantly increase tissue oxygenation. Enhanced oxygen levels can support the metabolic needs of compromised grafts and flaps, promoting cell survival and tissue repair (Gill & Bell, 2004).

  2. Angiogenesis Stimulation: HBOT has been shown to stimulate the formation of new blood vessels (angiogenesis) in and around the graft or flap area. This process improves the blood supply to the tissue, which is critical for its survival and integration (Marx, 1998).

  3. Reduction of Edema: Swelling due to fluid accumulation can compromise the blood supply to surgical repairs. HBOT can help reduce edema, thereby preventing compression of blood vessels and improving circulation to the graft or flap (Zamboni et al., 1997).

  4. Enhanced Infection Control: Infections can significantly impact the success of grafts and flaps. The high levels of oxygen delivered during HBOT possess antimicrobial properties, which can help control and prevent infections, a crucial factor in the healing process (Gill & Bell, 2004).

Clinical Evidence Supporting HBOT for Failing Grafts and Flaps

A body of clinical evidence supports the use of HBOT in the management of failing grafts and flaps. A study by Marx (1998) demonstrated that HBOT could significantly improve the survival rate of compromised flaps and grafts by enhancing oxygenation and promoting angiogenesis. Similarly, research by Zamboni et al. (1997) found that HBOT reduced postoperative edema and improved the success rate of skin grafts.

Moreover, a systematic review by Gill and Bell (2004) concluded that HBOT should be considered as an adjunctive therapy for grafts and flaps at risk of failure. The review highlighted HBOT's role in improving oxygen delivery to the tissue, stimulating angiogenesis, and enhancing the body's ability to fight infection.


Hyperbaric Oxygen Therapy represents a promising adjunctive treatment for failing grafts and flaps, offering benefits such as improved oxygenation, stimulation of angiogenesis, reduction of edema, and enhanced infection control. By addressing the critical factors that contribute to graft and flap failure, HBOT can significantly improve the outcomes of reconstructive surgeries, ensuring better healing and integration of surgical repairs. While further research is needed to optimize treatment protocols, the existing evidence supports the incorporation of HBOT into the multidisciplinary management of compromised grafts and flaps.


  • Gill, A. L., & Bell, C. N. A. (2004). "Hyperbaric oxygen: Its uses, mechanisms of action and outcomes." QJM: An International Journal of Medicine, 97(7), 385-395.

  • Marx, R. E. (1998). "A new concept in the treatment of osteoradionecrosis." Journal of Oral and Maxillofacial Surgery, 41(6), 351-357.

  • Zamboni, W. A., Roth, A. C., Russell, R. C., Graham, B., Suchy, H., & Kucan, J. O. (1997). "Morphologic analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen." Plastic and Reconstructive Surgery, 99(6), 1712-1719.

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