In cases of compromised skin grafts and flaps, where the oxygen supply is limited, HBOT is an FDA-approved treatment option. In these cases, a patient is placed in a hyperbaric chamber and given 100 percent oxygen at increased atmospheric pressure. This floods the wound area and the skin graft or flap with oxygen. In addition to supplying oxygen to the transplanted tissue, the increased oxygen levels encourage capillary growth, reduce swelling and edema, encourage white blood cell production to fight possible infection, and give the skin graft or flap a new chance to continue the intended healing process.

While HBOT is only FDA-approved for treating compromised grafts and flaps, it can be beneficial to treat them with hyperbaric oxygen before they become compromised in order to promote complete healing.

What is a Skin Graft?

A skin graft is a piece of healthy skin that is removed from an area of the body. That piece of skin is then transplanted to the wound area to allow for healing and closure of the wound. Skin grafts typically come from the leg, inner thigh, upper arm, forearm, or buttocks. Skin grafts can reduce the healing time of a large wound as well as improve the function and appearance of the area once healing is complete. A skin graft can include just a thin layer of skin or can be a full thickness skin graft which includes the epidermis and the entire thickness of the dermis layer. Skin grafts survive as oxygen and nutrients transfer to them from the underlying tissue of the wound.

A skin flap is like a graft, except the piece of skin is not completely removed, but rather cut away and moved over to cover a wound. This leaves the blood supply to the flap intact, so it is not dependent on establishing a new supply. This makes it more resilient than a graft and makes it easier to match skin tone and texture for healing. Whereas skin grafts only include the skin, flaps can contain skin and fatty tissue, as well as muscle. A free flap is where a flap is created and cut from its blood supply and placed on the wound and surgically reattached to the surrounding blood vessels.

How do Skin Grafts and Flaps Become Compromised?

While skin grafts and flaps are very successful methods for closing wounds, they do not always work. The graft or flap does not receive enough oxygen to thrive and becomes compromised. Common causes for compromised grafts and flaps include:

• Previous radiation to the wound area
• Diabetes mellitus
• Smoking, nutritional status, and age can affect the blood flow in flaps
• Poor blood circulation
• Underlying infection
• Compromised immune system

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