Overview of Hyperbaric Therapy for Skin Grafts and Flaps
Hyperbaric oxygen therapy, or HBO2T, is a treatment that involves breathing in pure oxygen in a special room or a small tube. While it may not be needed for regular, unproblematic skin grafts or flaps (pieces of tissue moved from one part of the body to another), it can be incredibly beneficial for those that are compromised. Compromised tissues could be ones damaged by radiation therapy or in cases where there’s poor blood flow or low levels of oxygen.
This perspective is backed by the Society of Undersea and Hyperbaric Medicine, a renowned international organization that determines the guidelines for hyperbaric medicine’s use. Skin grafts or flaps are medical procedures that help in the healing process by transferring healthy skin to injured areas. Sometimes, the skin is moved from a distant location or rotated from a neighboring location, while its blood supply is kept intact.
Healthy blood supply is critical for these grafts or flaps and it needs to be preserved without stress or twisting of the blood vessels involved. HBO2T promotes faster healing and better success rates in these delicate cases by boosting the body’s ability to carry oxygen in the bloodstream. In fact, studies have shown that HBO2 treatment can increase the blood’s oxygen carrying capacity by up to 7%, which is a significant improvement for healing. HBO2T also stimulates the growth of new blood vessels and reduces swelling, both of which contribute to a better environment for healing.
HBO2T can be particularly beneficial in certain scenarios. For example, severe injuries with swelling can put any skin grafts or flaps at risk, while burn patients often face several factors that can affect the healing of their grafts. HBO2T helps counteract these challenges by enhancing blood flow and reducing the swelling. Furthermore, HBO2T can also help lower the risk of infections, which is a common concern among burn patients, by inhibiting and killing certain types of bacteria.
Anatomy and Physiology of Hyperbaric Therapy for Skin Grafts and Flaps
Free skin grafts, which use only a part of the skin’s thickness, need the recipient’s local tissue to accept them. This process heavily depends on microvasculature, which is the network of tiny blood vessels in the body. For the graft to be accepted, neovascularization, which is the natural formation of new blood vessels, is crucial. On the other hand, full-thickness rotation flaps, another type of skin graft that involves the entire thickness of the skin, rely on the blood vessels being intact in the area where the graft is being moved.
Why do People Need Hyperbaric Therapy for Skin Grafts and Flaps
There’s no need for a special type of treatment called hyperbaric oxygen therapy for skin grafts and flaps that are healthy and not in crisis. Hyperbaric oxygen therapy, also known as HBO2 therapy, involves using a special chamber to breathe pure oxygen, and has been found useful for treating a range of conditions.
Particularly, it’s approved for use in some cases where there’s a disruption to blood flow, which is also known as vascular compromise. For instance, if you have had radiation treatment in the past, it can lead to reduced small blood vessels (microvascularization) and cause unfavorable conditions for your tissue. HBO2 therapy has been shown to be beneficial in these scenarios.
Also, if you have had severe injuries, like crush injuries, that lead to damage once blood flow returns to the tissue (which is known as reperfusion injuries), HBO2 therapy can help. Even if you have suffered burns and are treated with skin grafts, HBO2 therapy can be beneficial.
When a Person Should Avoid Hyperbaric Therapy for Skin Grafts and Flaps
Hyperbaric oxygen therapy, a treatment where you breathe in pure oxygen in a pressurized chamber, can sometimes lead to problems, usually due to something called barotrauma. Barotrauma is a physical injury that can occur in areas where there is a pocket of trapped air, like in the lung or the middle ear, because the gases can expand when the pressure changes during the treatment — like what happens with changes in altitude. If a person has had a pneumothorax, a collapsed lung, that isn’t treated, they should not have hyperbaric oxygen therapy. This is because it could quickly lead to a serious condition called tension pneumothorax and even death.
Another issue can be the presence of pulmonary blebs, which are small, thin areas in the lung, and people who have emphysema (a lung condition) and retain carbon dioxide in their lungs. Also, giving someone certain drugs can be a problem. For example, disulfiram can stop a substance that protects against oxygen toxicity, one of the risks of this treatment. Two other drugs, cisplatinum and sulfamylon can negatively affect wound healing. The drug bleomycin can cause lung inflammation which is similar to pneumonia (interstitial pneumonitis).
More minor issues or considerations could be sinusitis (inflammation of the sinuses), seizures, pregnancy, and the presence of certain medical devices within the body such as heart pacemakers or pain relief pumps inserted into the space around the spinal cord (epidural pumps). Feelings of claustrophobia, especially when using a specific type of hyperbaric oxygen treatment chamber known as a monoplace chamber, can also be a potential issue.
Equipment used for Hyperbaric Therapy for Skin Grafts and Flaps
Hyperbaric oxygen therapy is a unique treatment you would receive in a special chamber that is highly regulated. These chambers are either single-person chambers, allowing only one patient at a time, or multi-person chambers which can hold more than one patient and a supervisory doctor. The multi-person chambers are versatile as they can hold patients who need to be on breathing machines or those who need other specific types of hospital equipment, which may not fit in a single-person chamber.
This process is strictly monitored – everything from removing carbon dioxide to ensuring the oxygen and air are pure is supervised. Regular safety inspections are carried out, and the team looking after you needs to be specially trained for this kind of therapy. A safety director is also assigned to each treatment center to ensure all guidelines are followed. The worst thing that could happen during a treatment is either a problem with the chamber itself or a fire. Nevertheless, with regular safety checks and the careful oversight of the team, these risks are largely avoided.
Preventing fire is an integral aspect of the treatment. For a fire to occur, you need a flammable material, a spark, and oxygen. With this in mind, there are strict rules on what you can take into the chamber. Items like oils, electronics, or any item that isn’t specifically approved are not allowed. You’re required to wear special gowns, and regular clothing isn’t allowed. To prevent static sparks, patients are also “grounded”, which is a safety measure that helps prevent electricity build-up. If there’s a need for electronic equipment that hasn’t been approved, it can only be used away from the open chamber.
Who is needed to perform Hyperbaric Therapy for Skin Grafts and Flaps?
The doctors and all staff members, even those who clean, need special training to work with hyperbaric medicine and its equipment. Hyperbaric medicine involves using a special chamber where patients breathe in pure oxygen to help their bodies heal faster. Every doctor in charge has to go through at least 40 hours of training in hyperbaric medicine.
Doctors can also become specialists in undersea and hyperbaric medicine. For this, they have to take extra training for a whole year, called a fellowship. The technicians who work with hyperbaric equipment also need to take a 40-hour training course in how to use the special hyperbaric machines.
There’s also a safety officer who gets additional training about how to keep everyone safe and how to maintain the equipment. The people who clean the equipment need to know the special procedures for cleaning the see-through, one-person oxygen chambers made of acrylic. They also have to learn other special information about taking care of and maintaining chambers that can hold more than one person.
How is Hyperbaric Therapy for Skin Grafts and Flaps performed
Hyperbaric dives, a type of treatment where you breathe in pure oxygen in a special room or tube under high pressure, have established routines depending on the medical issue being addressed. These treatments usually last for 2 hours each day, with two breaks of 10 minutes each to avoid having a seizure due to too much oxygen. The pressure inside the room or tube is usually set at 2.4 times the normal air pressure and you’ll breathe in 100% oxygen. Normally, this routine goes on for about 30 sessions, but it can be extended if the doctor thinks you’ll benefit more from additional sessions.
Possible Complications of Hyperbaric Therapy for Skin Grafts and Flaps
Hyperbaric oxygen therapy, a treatment which involves breathing oxygen in a special high-pressure room, may sometimes lead to complications. The most common one is called barotrauma. This happens when gases expand in a closed space and may cause issues like irritation or rupture of the eardrum, which is the thin layer that separates your ear canal from your middle ear.
More serious injuries can occur too, such as air trapped in the area between the lungs (pneumothorax), rupture of small blood vessels, and damage to the inner, middle, and external parts of the ear. In extreme cases, the therapy could trigger seizures, convulsions, fluid buildup in the lungs (pulmonary edema), or bleeding in the lungs. The presence of fire or explosions in the chamber are a rare but critical danger.
It’s also important to remember that hyperbaric oxygen therapy isn’t always effective for treating all conditions. For example, in cases of failed or damaged skin flaps or grafts, prolonged treatments may sometimes be necessary, but still, the treatment might not work. If the skin flap or graft is lost, a procedure to remove dead tissue (debridement) may be required, leading to loss of skin coverage. This could greatly impact a patient’s overall health and even potentially increase the risk of death.
What Else Should I Know About Hyperbaric Therapy for Skin Grafts and Flaps?
It’s very important to keep an eye on skin grafts and flaps (pieces of tissue moved from one part of the body to another) for any signs of damage or potential damage. Starting treatment with hyperbaric oxygen therapy (a treatment that involves breathing pure oxygen in a pressurized room or tube) as soon as possible can lead to improved outcomes. This therapy helps to increase the amount of oxygen your blood can carry, which aids in healing and repairing tissues.
