Article – 1 - Compromised Skin Grafts and Flaps
Title: Preconditioned hyperbaric oxygenation protects skin flap grafts in rats against ischemia/reperfusion injury.
Authors: Kang N, Hai Y, Liang F, Gao CJ, Liu XH
Digital Object Identifier (or PMID etc): PMID: 24676940 PMCID: PMC4055471
Keywords: Nil
Abstract: Hyperbaric oxygen (HBO) therapy is an effective therapy for ischemia/reperfusion (I/R) injury of the brain, small intestine, testes and liver. However, the detailed molecular mechanisms underlying the effect of HBO therapy remain undetermined. In the current study, the hypothesis that preconditioning rats with HBO protects grafted skin flaps against subsequent I/R injury was investigated. In addition, the molecular mechanisms underlying HBO therapy were characterized by analyzing the roles of the following important inflammatory factors: High mobility group protein 1 (HMGB1) and nuclear factor-κ B (NF-κB). A total of 40 rats were randomly divided into the following five groups: (i) Sham surgery (SH); (ii) ischemia followed by reperfusion 3 days following surgery (I/R3d); (iii) ischemia followed by reperfusion 5 days following surgery (I/R5d); (iv) HBO preconditioning (HBO-PC) and ischemia followed by reperfusion 3 days following surgery (HBO-PC+3d); and (v) HBO-PC and ischemia followed by reperfusion 5 days following surgery (HBO-PC+5d). For the surgical procedure, all pedicled skin flaps were first measured and elevated (9x6 cm). The feeding vessels of the skin flaps were subsequently clamped for 3 h and released to restore blood flow. The rats in the HBO-PC+3d and HBO-PC+5d groups received 1 h HBO for 3 and 5 consecutive days, respectively, prior to surgery. Following surgery, the rats were euthanized, and grafted tissues were collected for western blotting and immunohistochemistry. HBO-PC increased blood perfusion in epigastric skin flaps and attenuated I/R injury following skin flap graft. Additionally, the elevated expression of HMGB1 and NF-κB proteins during I/R injury was attenuated by HBO-PC treatment.
Conclusion: HBO-PC may therefore be applied to reduce I/R injury and improve the survival rate of grafted skin flaps. The molecular mechanisms underlying the effect of HBO therapy are associated with the attenuation of inflammatory responses.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/24676940
Full text URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055471/
Article – 2 - Compromised Skin Grafts and Flaps
Title: Effect of HMGB1/NF-κB in hyperbaric oxygen treatment on decreasing injury caused by skin flap grafts in rats.
Authors: Liang F, Kang N, Liu X, Yang J, Li Z, Tan JW
Digital Object Identifier (or PMID etc): PMID: 23884820
Keywords: Nil
Abstract: Skin flap grafting (SFG) is a common surgical operation, and hyperbaric oxygen treatment (HBOT) is an important strategy for restoring the grafted skin flap. Thus, we employed a rat skin flap grafting model treated with HBO, and expression levels of high mobility group protein 1 (HMGB1) and NF-kappaB (nuclear factor-kappaB) were characterized. Forty rats were randomly assigned to 5 groups: (1) sham-operation (SH), (2) ischemia followed by reperfusion 3 days after operation (IR3d), (3) ischemia followed by reperfusion 5 days after operation (IR5d), (4) ischemia followed by reperfusion and HBOT 3 days after operation (HBO3d), and (5) ischemia followed by reperfusion and HBOT 5 days after operation (HBO5d). Elevated pedicled skin flaps were designed (size, 9 cm × 6 cm), and feeding vessels were clamped. The microvascular clamp was removed 3 h later and flow was restored. In the HBO3d and HBO5d groups, rats received 1 h of hyperbaric oxygen (HBO) starting immediately after surgery for 3 days and 5 days, respectively. Upon completion of animal experiments, rats were euthanized by general anesthesia, and blood samples were taken for testing. The tissues were sectioned for western blotting and immunohistochemical staining.
Results: Expression of HMGB1 and NF-κB proteins in the HBO groups was lower than in the IR groups.
Conclusion: The results suggest that HBOT can be used to reduce ischemia-reperfusion (IR) injury of skin flap grafts.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/23884820
Full text URL:
http://www.europeanreview.org/wp/wp-content/uploads/2010-20181.pdf
Article – 3 - Compromised Skin Grafts and Flaps
Title: Hyperbaric oxygen (HBO2) treatment for a failing facial flap.
Authors: McCrary BF.
Digital Object Identifier (or PMID etc): PMID: 17267665 PMCID: PMC2599968
Keywords: Animals, Bites and Stings, Child, Preschool, Dogs, Facial Injuries/surgery, Female, Graft Rejection/therapy, Humans, Hyperbaric Oxygenation, Ischemia/therapy, Skin Transplantation, Surgical Flaps/blood supply
Abstract: Hyperbaric oxygen (HBO2) is an approved treatment for 13 pathological entities. One of these indications--a failing facial flap--is presented in this case report of a traumatic wound to the face and right axilla after an unprovoked pit bull attack on a 4 year old girl. Surgical repair was started acutely but the facial flap became congested and ischaemic, indicating deterioration of the blood supply. HBO2 treatments were initiated twice a day, resulting in remarkably decreased swelling and discomfort after the first treatment. Leeching was also used to assist with reduction of venous congestion in the flap. The patient was discharged 5 days later with a well perfused, mostly intact, incision with minimal tenderness. Surgical repair was required for a small area of wound dehiscence. Photographs documenting the patient's progress with HBO2 are presented.
Conclusion: A discussion of the mechanisms of action of HBO2 and its beneficial effects is provided in this case.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/17267665
Full text URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2599968/
Article – 4- Compromised Skin Grafts and Flaps
Title: Effect of hyperbaric oxygen therapy on fetal spinal grafts: an experimental study
Authors: Kutlay, M; Colak, A; Demircan, N; Akin, ON; Kibici, K; Dundar, K; Yildirim, S
Digital Object Identifier (or PMID etc): PMID: 11419361
Keywords: Nil
Abstract: In neural transplantation, lack of oxygen supply to the graft in acute stage is an important problem. This study was undertaken to evaluate the effects of hyperbaric oxygen (HBO2) on fetal spinal grafts. Spinal cord tissues obtained from 16-day fetal rats were transplanted into the spinal cord of adult Wistar rats (n = 30). After transplantation, they were randomly divided into two groups (n = 15 for each group); Group 1 received transplant alone, group 2 received transplant and HBO2 therapy consisting of 100% oxygen at 2.5 atm abs for 90 min twice a day for 7 days. Seven days after their surgery, all animals were killed for histologic examination. Degenerative changes, parenchymal integrity, host spinal cord edema, and vascularization of the graft were scored on a 3-point scale. Scores of these parameters were statistically analyzed. The graft survival rates in groups 1 and 2 were 54.5% and 71.4%, respectively. Animals treated with HBO2 showed statistically less spinal cord edema than the untreated groups (P < 0.05). Parenchymal integrity was also significantly better in this group (P < 0.05).
Conclusion: The results indicate that edema reduction effect of HBO2 prevents the displacement of graft from the gap and contributes to the integration between the graft and host.
Article – 5 - Compromised Skin Grafts and Flaps
Title: Clinical experience with hyperbaric oxygen therapy in the salvage of ischemic skin flaps and grafts.
Authors: Bowersox, JC; Strauss, MB; Hart, GB
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: We reviewed the records of 105 patients with ischemic skin flaps and grafts who received hyperbaric oxygen as an adjunctive treatment. Sixty-three percent of the patients with skin grafts and 90% of the patients with skin grafts had risk factors that were considered to be poor prognostic indicators of flap or graft survival. Eighty-nine percent of threatened flaps and 91% of the threatened skin grafts were salvaged. All but 2 of the patients treated were able to tolerate hyperbaric oxygen therapy: minimal side effects of barotrauma and confinement anxiety were easily managed. Nine patients with histories of impaired wound healing or underlying diseases (diabetes mellitus, peripheral vascular disease) received hyperbaric oxygen treatments before skin grafting. There was greater than 95% take of the skin grafts in this group.
Conclusion: Treatment failures in the patients in this series were associated with older age, delay in initiation of treatment, and the presence of underlying factors associated with poor wound healing.
Article – 6 - Compromised Skin Grafts and Flaps
Title: Efficacy of hyperbaric oxygen on survival of random pattern skin flap in diabetic rats.
Authors: Zhang, T; Gong, W; Li, Z; Yang, S; Zhang, K; Yin, D; Xu, P; Jia, T
Digital Object Identifier (or PMID etc): Nil
Abstract: This study was designed to determine if hyperbaric oxygen improved random pattern skin flap survival in diabetic rats. Cranially-based, 4 x 10 cm dorsal skin flaps were raised in 38 diabetic rats induced by streptozocin (STZ). The animals were randomly divided equally into two groups. Group A was a control group observed in the room air and Group B was the experimental group, which received hyperbaric oxygen (HBO2) therapy. The HBO2 regimen consisted of 90 minutes of treatment with 100% O2 at 2.5 ATA (atmosphere absolute ATA) per day for 7 consecutive days. On the 7th postoperative day, we measured the necrotic flap area and the new growth number of capillary vessel and the granulation tissue thickness.
Results: The percentage of necrosis flap area for group A was 50.5 +/- 10.5%; for group B it was 38.5 +/- 9.3%. The reduction in necrosis flap area was highly significant (p < 0.01) compared with controls. Also, new-growth capillary vessel and granulation tissue thickness were statistically different between the two groups.
Conclusion: The findings of this study demonstrated beneficial effects of HBO2 in improving diabetic rat dorsal skin flap survival.
Article – 7- Compromised Skin Grafts and Flaps
Title: Skin allograft rejection and hyperbaric oxygen treatment in immune-histoincompatible mice
Authors: Erdmann, D; Roth, AC; Hussmann, J; Lyons, SF; Mody, NJ; Kucan, JO; Russell, RC
Digital Object Identifier (or PMID etc): PMID: 8574127
Abstract: The effect of hyperbaric oxygen (HBO) as an immunosuppressive agent was evaluated by using a highly immunogenic skin allograft mouse model. Immune-histoincompatible female C57BL/6 and BALB/c mice (N = 30) were randomly assigned to three groups receiving no treatment (control group), low dose HBO treatment (two treatments once a week), and intermediate HBO treatment (two treatments 3 times/wk) 1 wk before and 2 wk after transplantation of a 1.5 x 2 cm full thickness skin allograft from the back. Rejection was observed a Day 7 and was completed 14 days after surgery in controls.
Conclusion: Low dose and intermediate HBO treatment delayed skin allograft rejection, which was histologically confirmed.
Article – 8 - Compromised Skin Grafts and Flaps
Title: Immunohistochemical expression of apoptosis and VEGF expression on random skin flaps in rats treated with hyperbaric oxygen and N-acetylcysteine.
Authors: da Rocha, FP; Fagundes, DJ; Rivoire, HC; Rech, FV; Almeida, MW; Pires, JA
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: We sought to investigate the role of hyperbaric oxygen (HBO2), N-acetylcysteine (NAC), and HBO2 plus NAC (HN) on the immunohistochemical expression of caspase-3 and the vascular endothelial growing factor (VEGF) on random skin flaps of rats (modified McFarlane design). Thirty-two male Wistar rats were randomly divided into four groups: GS (sham--n = 8); GNAC (N-acetylcysteine--n = 8); GHBO2 (hyperbaric oxygen--n = 8); and GHN (HBO2 plus NAC--n = 8). A rectangular skin flap (2 x 8 cm2) was dissected from the muscular dorsal layer, preserving a cranial pedicle. Polyethylene film was placed over the muscular layer, and an interrupted 3.0 nylon suture fixed the flap into the original place. On the eighth day, full-thickness biopsies (2 x 1 cm2) were collected from the proximal, middle and cranial areas of the skin flap, and in a site away from the flap labeled the control area.
Results: The expression of VEGF in the skin layers (epidermis, dermis, subcutaneous muscles) and vessels showed no significant difference among the groups. Apoptotic cells were significantly increased in the middle area of the flap in all groups. The major increase occurred in GS and GNAC. HBO2 significantly decreased cleaved caspase-3-positive cell numbers in the skin layers and vessels of the three areas.
Conclusion: HBO2 showed a protective effect in the ischemic skin flap that was associated with reduced expression of apoptosis. GNAC and GHN were not associated with lower expression of apoptosis, and poor results were observed in GNAC. The combination of NAC and HBO2 did not show better results than using them separately. The expression of VEGF in skin layers and vessels did not show a significant difference in our modified McFarlane flap model. The results suggest that the diffusion of oxygen through the interstitial space was the determining factor for the more favorable results of HBO2 in the decrease of apoptosis expression.
Article – 9- Compromised Skin Grafts and Flaps
Title: Effect of Hyperbaric Oxygen on the Take of Composite Skin Grafts in Rabbit Ears.
Authors: Rubin, JS; Marzella, L; Myers, RA; Suter, C; Eddy, H; Kleiman, L
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: It is generally accepted that take of composite chondrocutaneous grafts is unreliable for tissue further than 0.75 c. from the graft edge. On this basis, surgeons are hesitant to use large composite grafts for wound reconstruction. In this study, 20 composite chondrocutaneous grafts measuring 4 x 2 cm were raised in the ears of 10 New Zeland rabbits. Animals were randomly assigned to control and hyperbaric (experimental) groups. Experimental animals received 100% O2 at 2 ATA (33 fsw equivalent) twice daily for a total of 21 treatments. Animals were killed on postsurgical Day 18.
Conclusion: Grafts in expermintal animals demonstrated greater survival than grafts in control animals. Statistical significance (p = 0.01) was only obtained at Day 9 of the hyperbaric oxygen treatment. Light and electron microscopy demonstrated repair phenomena in both groups.
Article – 10 - Compromised Skin Grafts and Flaps
Title: Hyperbaric Oxygen Therapy in the Management of Cochlear Implant Flap Necrosis.
Authors: Schweitzer, VG; Burtka, MJ
Digital Object Identifier (or PMID etc): Nil
Abstract: The most common complication resulting from cochlear implant surgery involves the skin flap: scalp breakdown, flap necrosis, and implant exposure requiring explantation. A 5.4% flap complication rate has been reported with the C-shaped postauricular flap (anteriorly based on the superficial temporal and occipital arteries) in contrast to a 0% flap complication rate with the Australian inverted U-flap (inferiorly based on the occipital artery). The literature is scant concerning detailed management of flap necrosis to obviate cochlear implant removal.
Conclusion: Presented is an illustrative case of full thickness C-shaped flap necrosis with resultant exposure of a Nucleus 22-channel implant Successful wound management required pre- and postoperative hyper baric oxygen in conjunction with a transposition flap closure of the scalp defect. Cochlear explantation was not necessary, and postoperative rehabilitation and implant function were excellent.