An Evidence-Based Appraisal of the Use of Hyperbaric Oxygen ... : Plastic and Reconstructive Surgery (original) (raw)

RECONSTRUCTIVE WOUND-HEALING SUPPLEMENT: ORIGINAL ARTICLES: RECONSTRUCTIVE

Friedman, H I. F. M.D., Ph.D.; Fitzmaurice, M M.D.; Lefaivre, J F. M.D.; Vecchiolla, T M.S.N.; Clarke, D

Columbia, S.C.

From the Department of Education, Sisters of Charity Providence Hospital; and the Department of Hyperbaric Medicine, Palmetto Health Richland Hospital

Received for publication July 7, 2004.

Harold I. Friedman, M.D., Ph.D., Division of Plastic Surgery, Department of Surgery, University of Southern California School of Medicine, No. 2 Medical Park Road, Suite 402, Columbia, S.C. 29203, [email protected]

Abstract

Summary:

Hyperbaric oxygen has been advocated, both as an adjunctive or primary form of treatment, for a variety of disorders, including gas gangrene, osteoradionecrosis, and carbon monoxide poisoning. It has also been used to improve ischemic wounds before skin grafting and to support ischemic flaps. In this review, we analyze the available literature that investigates the use of hyperbaric oxygen for composite grafts, skin grafts, random flaps, distant flaps, and free flaps. An appraisal of the level of evidence for each of these uses of hyperbaric oxygen is offered. Although there are a significant amount of animal data supporting the application of hyperbaric oxygen for grafts and flaps, there is very little clinical information other than case reports and series to sustain its choice over other modalities of therapy. Multicenter prospective clinical studies are clearly needed comparing hyperbaric oxygen to other mechanical or pharmacologic interventions to improve wound healing for grafting or to support flap survival.