The most obvious sign of an unhealthy skin graft is darkening skin that lacks the pink appearance of healthy skin. Hyperbaric oxygen therapy can significantly increase the likelihood of graft survival and enhance skin graft outcomes. Regular HBOT sessions effectively treat compromised skin grafts and flaps by restoring and strengthening the natural body processes needed to ensure skin-grafting success. HBOT also helps to increase the viability of any compromised tissue, reducing the need for additional grafting procedures.
Hyperbaric oxygen therapy makes it possible to deliver the concentrated oxygen needed for skin graft healing. Our skin cannot survive without oxygen, and the most effective way to provide skin cells with oxygen is through the blood.
When white blood cells receive enough oxygen, they can effectively kill bacteria, reduce swelling, and allow the rapid reproduction of new blood vessels. Your treatment takes place in a clear acrylic chamber where you can comfortably recline and view your surroundings at all times. You can sleep, watch TV, listen to music, or just relax as therapeutic oxygen rejuvenates your body. The number of hyperbaric oxygen treatments needed for skin graft healing varies, so you will be evaluated by our provider during your first appointment to determine your treatment plan.
Our skilled personnel will be happy to discuss your unique medical needs and help you find the best treatment plan for a full recovery. And remember—no doctor referral is needed.
In our experience, one-third of lower limb skin grafts failed at 6 weeks. However, these rates are in a heterogeneous population with a variety of different indications, operative techniques, and followup. In addition to PVD and immunosuppressant use, we found increased BMI to be strongly associated with skin graft failure. The association of increased BMI and skin graft failure has not been described before. Penington and Morrison had identified waist to hip ratio to be associated with FTSG failure in the head and neck region in 14 patients [ 7 ].
Obese individuals are at increased risk of wound complications including wound infection, dehiscence, hematoma, and seroma formation [ 8 ]. Local and cellular factors including reduced microperfusion and decreased tissue oxygenation have been thought to play a part in this [ 7 , 8 ]. Studies to explore specific mechanisms and impact of obesity as independent risk factor for poor operative outcome are still a much needed area for future research.
A prospective study randomised 68 patients undergoing elective operations requiring radial forearm free flaps into receiving STSG or FTSG to the radial forearm free flap donor site [ 9 ]. No difference in outcomes was seen between the two groups, although patients with STSG required significantly more wound dressing changes compared to those who had FTSG.
However, STSG remain the most common method of skin coverage in grafting of the lower limbs owing to better scar quality than healing by secondary intention, ease of use, and ability to expand coverage through meshing [ 10 ]. The wound defects in the lower limb are often too large to be closed primarily and local flap repair can be difficult to achieve especially in elderly populations.
It is also simpler to undertake revision surgery and oncological surveillance in patients who have had skin graft repairs compared to those with local flap repairs [ 10 ]. No difference in outcomes or complications was seen between patients placed on bed rest and those immediately mobilised. The vast majority of patients requiring lower limb grafts were placed on bed rest by the operating surgeon in our study.
Bed rest is still widely used throughout the world despite an increasing body of evidence showing no significant benefit in outcomes [ 11 ]. Its popularity may be partly due to the clinical observation of decreased tissue oedema and perceived less graft disruption with limb elevation and bed rest, especially in this population with high rates of venous insufficiency. Similarly, no benefit in graft success rate was seen with the use of negative pressure dressings; a recent Cochrane review found no evidence to support or refute the effectiveness of commercial negative pressure dressing to improve healing rates of skin grafts [ 12 ].
Lower limb skin grafts have high failure rates. Knowledge of these factors is important in preoperative assessment to identify patients at increased risk of postoperative complications. A larger prospective trial assessing the comparative effectiveness of different strategies aimed at minimising complications of lower limbs is needed. The authors declare that there is no conflict of interests regarding the publication of this paper.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues. Academic Editor: Masutaka Furue. It may look very red for 2 to 3 months. During this time:. Keep the skin moist in these areas. Apply nonmedicated skin lotion often during the day. Do this for 3 to 4 months or as advised. Do not soak the skin graft site in water. Ask your healthcare provider about the best way to keep the skin graft dry when showering for 1 to 2 weeks.
Do not take baths for 2 to 3 weeks. Protect the skin graft and donor site from the sun for 12 months. Wear clothing over them or use a sunscreen lotion with an SPF of 30 or higher. Signs of infection, including increasing swelling or redness of the graft, white or bad-smelling discharge from the graft, red streaks from the graft site, or pus at the wound site. Your bandages Your skin graft will have a bandage dressing. General home care Plan to rest at home for up to a week after the surgery.
Expect some light bleeding, swelling, bruising, redness, and discomfort. If you were given prescription pain medicine, take it as instructed. Follow any other instructions you were given. Caring for the bandaged graft site Do not touch the bandage.
Keep the bandaged area clean. Avoid getting dirt or sweat on it. If the bandage comes off or is damaged or very dirty, call your healthcare provider. If the tube on your vacuum bandage comes off, call your healthcare provider. Caring for the bandaged donor site The donor site will have a thin bandage.
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