Skin Grafts
Skin grafts are used to cover traumatic tissue defects, burns, chronic ulcers or surgical excision sites where primary wound closure is not possible.
Successful graft integration—the process through which the graft develops vascular connections with the underlying wound bed and survives as living tissue—is the principal objective of every skin grafting procedure.
During the first 48 to 72 hours, the graft survives entirely through the diffusion of nutrients from the wound bed, before new vascular connections have developed.
This critical initial phase depends entirely on adequate oxygenation of the underlying tissue. Patients with angiopathy, diabetes, radiation-induced tissue injury or impaired microcirculation face a greater risk of graft failure because the wound bed cannot provide sufficient oxygen to the newly placed graft.
Characteristics of Skin Grafts
Failure of graft integration typically begins as localised necrosis at the margins or centre of the graft, where the distance from the capillaries within the wound bed is greatest and oxygen diffusion is inadequate.
Unless this process is addressed, the necrosis may spread and the graft may become detached.
Preventing this progression requires the oxygenation of the wound bed to be optimised both before and after graft placement. High-risk patients, particularly those with a history of radiotherapy or severe angiopathy, often have very low tissue oxygen tension, which can be measured using transcutaneous oxygen pressure (TcPO₂). Improving these levels is an important prerequisite for successful graft integration.
Scientific Studies
Support for compromised skin grafts is recognized by the Undersea and Hyperbaric Medical Society (UHMS) and the European Committee for Hyperbaric Medicine (ECHM) as an approved indication for hyperbaric oxygen therapy, particularly in patients with conditions that place graft survival at risk.
Clinical studies have reported significantly higher rates of successful graft integration, a reduced need for repeat procedures and better final skin quality in patients who received hyperbaric oxygen therapy.
The mechanism of action combines an immediate improvement in wound-bed oxygenation during the critical initial phase, stimulation of neovascularisation to accelerate vascular connections between the graft and the underlying tissue, and anti-inflammatory protection that reduces the risk of graft failure.
The Role of Hyperbaric Oxygen Therapy
In skin grafting, hyperbaric oxygen therapy may be used both before surgery to improve the biological condition of the wound bed and after surgery to support the critical phase of graft integration.
Preoperative treatment, usually consisting of 10 to 20 sessions, aims to improve the TcPO₂ of the wound bed to levels that support successful graft survival.
Postoperative treatment, typically involving a further 10 to 20 sessions, helps ensure that the wound bed supplies sufficient oxygen to the graft while vascularisation develops. At the same time, the stimulation of neovascularisation accelerates the formation of new vascular connections.
The treatment plan is always developed in collaboration with the plastic surgeon or dermatological surgeon.