Effectiveness of hyperbaric oxygen therapy as an adjuvant to conventional therapy in the salvage of compromised flaps: Randomized Controlled Study

Flap surgery remains a cornerstone of reconstructive procedures using skin grafts and flaps are essential for

restoring tissue integrity following trauma, chronic disease, surgical excision, or burns. However, despite

optimal planning and surgical technique, flap or graft failure may still occur due to factors such as ischemia,

venous congestion, or poor wound bed quality. These complications can result in delayed healing, additional

surgical interventions, increased healthcare costs, and psychosocial distress for patients.

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Current treatment strategies for compromised grafts and flaps include local wound care, vacuum assisted

closure, surgical debridement, and additional reconstructive procedures. These are associated with increases

in healthcare- associated costs, patient discomfort, and may lead to additional donor site morbidity. Flap

surgeries widely used in reconstructive procedure to restore ischemic reperfusion resulting from trauma,

surgical excision or burns.

Hyperbaric oxygen therapy is an adjunctive treatment modality that deliver 100% oxygen at elevated

atmosphere pressure (1-2 ATA). It significantly increased dissolve oxygen in plasma due to elevated arterial

partial pressure of oxygen. Hyperbaric oxygen therapy provides administration of hyper oxygenation that

supports key process in wound healing, fibroblast proliferation, collagen synthesis, bacterial clearance by

generation of oxygen free radical. Its therapeutic benefits in restoring compromised flaps as it improves flap

viability & necrosis when surgical re-exploration reveals no correctable cause.

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HBOT may help in saving tissues that are compromised and not healing properly. It promotes salvage of

compromised flaps or grafts and uncomplicated healing after ablative or reconstructive surgery. It has also

been used to improve ischemic wounds before skin grafting and to support ischemic flaps.

This thesis aim to assess the efficacy of HBOT in improving outcomes of compromised flaps. There are

studies for HBOT on effectiveness in restoring compromised flap but their is lack of direct study which

comparing HBOT as an adjuvant to conventional therapy in compromised flap in term of effectiveness.