Wednesday, April 16, 2014
HBO Nugget 12
As hyperbaric medicine physicians, we may be asked to evaluate patients with compromised or failing flaps following reconstructive surgical procedures. With improved techniques in vascular and plastic surgery, there are an increasing number of these procedures being performed. Examples include:
· Breast reconstruction flaps
· Procedures to cover tissue defects after trauma
· Oral and maxillofacial procedures
One of the indications for the use of hyperbaric oxygen therapy (HBOT) is that of a failing flap or graft. HBOT can be used to promote flap survival. There are several theories describing how the flaps may benefit. One proposed theory is that there are small arteriovenous shunts that form within the flap and that HBOT may reduce these by causing vasoconstriction, thus increasing flow to more ischemic areas. The other is the well-known effect of migration of fibroblasts into hypoxic areas and induction of angiogenesis.
Typical recommended therapy is 2.0 ATA for 90 minute dives and, in some situations, the frequency could be twice a day. Treatment should always include close communication with the operating surgeon so that progress of the graft can be monitored.