What Are Skin Grafts?
Skin grafting is a commonly used surgical technique for covering extensive wounds, burns or chronic ulcers that cannot be closed through primary healing.
The success of a skin graft depends critically on the ability of the recipient site to accept it, particularly on the vascularity and oxygenation of the wound bed onto which the graft is placed.
Failure of graft incorporation, which may present as necrosis or partial or complete graft loss, is a serious complication. It may require further surgery, prolong hospitalization and place a considerable additional burden on the patient.
This complication occurs more frequently in patients with vascular disease, diabetes, radiation-induced tissue injury or chronic ischaemia, precisely because these underlying conditions have already impaired blood supply and tissue-healing capacity.
Skin Graft Placement
The first 48 to 72 hours after skin graft placement are critical. During this period, the graft initially survives through the passive diffusion of nutrients from the recipient bed before a vascular connection develops.
This phase, known as plasmatic imbibition, is the graft’s most vulnerable stage. If oxygenation of the recipient bed is inadequate, the graft may begin to undergo necrosis before revascularization can occur.
In patients with systemic vascular disease or radiation-induced tissue injury, the recipient bed already has a compromised blood supply. Successful graft incorporation is therefore inherently more difficult.
Addressing this biological challenge lies at the heart of the treatment strategy.
Clinical Studies
The use of hyperbaric oxygen therapy to improve skin graft incorporation is one of the established applications recognised by the Undersea and Hyperbaric Medical Society (UHMS) and the European Committee for Hyperbaric Medicine (ECHM).
Clinical studies involving high-risk patients, including those with diabetes, radiation-induced tissue injury or ischaemia, have demonstrated significantly higher rates of successful graft incorporation when hyperbaric oxygen therapy was included in the perioperative protocol.
The principal mechanism is improved oxygenation of the recipient bed. Increased tissue oxygen tension helps the graft survive the initial period before vascularisation, thereby improving the likelihood of successful incorporation. The stimulation of neovascularisation subsequently accelerates the formation of vascular connections between the graft and the recipient bed.
The Role of Hyperbaric Oxygen Therapy
In skin grafting, hyperbaric oxygen therapy is used primarily during the perioperative period. It may be administered for several days before surgery to improve the biological condition of the recipient bed and immediately afterwards to support the critical phase of graft incorporation.
Postoperatively, increased tissue oxygen tension helps meet the elevated metabolic demands of the newly placed graft. Its anti-inflammatory effects may also reduce the risk of an excessive inflammatory response that could contribute to graft separation.
In high-risk patients, a combination of preoperative and postoperative treatment may provide the greatest level of support.
A typical treatment course consists of 20 to 30 sessions, with progress assessed in collaboration with the plastic surgeon or vascular surgeon.