Hyperbaric Oxygen Therapy for Skin Grafts and Flaps
HBOT is an FDA-approved treatment for compromised skin grafts and flaps. Learn how it improves graft survival rates and who qualifies for treatment.
Hyperbaric Oxygen Therapy for Skin Grafts and Flaps
A compromised skin graft can mean the difference between a healed wound and a return to the operating room. HBOT is an FDA-covered option for salvaging grafts and flaps that are failing, and it’s used routinely in burn centers and reconstructive surgery programs.
What Compromised Skin Grafts and Flaps Are
A skin graft is tissue taken from a donor site and placed over a wound. The tissue has no blood supply of its own when it’s placed. It depends entirely on the wound bed developing new vessels to keep it alive.
A skin flap is different. It’s tissue moved to a new location while keeping a blood supply attached (a pedicle flap), or with the vessels surgically reconnected at the new site (a free flap). Flaps have better immediate circulation than grafts but are still vulnerable.
Compromise means the graft or flap is failing to survive. Signs include abnormal discoloration, slow or absent capillary refill, tissue breakdown, or developing infection. Without intervention, a failing graft means reoperation, prolonged healing, and potentially serious complications including wound infection and the loss of more tissue.
How HBOT Supports Graft and Flap Survival
The core problem with a failing graft or flap is hypoxia. The tissue isn’t getting enough oxygen to survive.
HBOT saturates blood plasma with dissolved oxygen, pushing it into tissue even where blood flow is limited or disrupted. It also stimulates angiogenesis — the growth of new blood vessels — which helps the graft bed build the vascular network the graft needs to take hold. And it reduces reperfusion injury, the cell damage that happens when blood flow fluctuates or is restored after a period of restriction.
HBOT is not used after routine, successful surgery. It’s an intervention for confirmed graft compromise. The sooner it starts after signs of compromise appear, the more tissue can potentially be saved.
What the Research Shows
HBOT for compromised grafts and flaps has been studied in clinical settings for decades. Boykin and colleagues (1996) published findings on the mechanisms by which HBOT improves tissue survival in compromised grafts, including the role of nitric oxide in wound repair and vessel formation. PMID: 8662569.
The Undersea and Hyperbaric Medical Society lists compromised grafts and flaps as an approved indication in its indications guidelines. It’s used as a standard adjunct in burn centers and plastic surgery programs when graft failure is identified.
Who Qualifies
Candidacy is determined by the operating surgeon and a hyperbaric medicine physician together. Not every failing graft qualifies. Severity, the patient’s overall health, and timing all factor into the decision.
Treatment is typically started as soon as compromise is confirmed. Waiting reduces the amount of tissue that can be preserved.
Typical protocols run 20 to 30 sessions at 2.0 to 2.4 ATA. Sessions are usually daily. Insurance may cover this indication when medical necessity is documented. Confirm coverage and prior authorization with your insurer before treatment begins.
For related conditions, see the pages on burns and non-healing wounds. You can also read more about what HBOT involves and review insurance basics.
FAQ
Is HBOT used for all skin grafts or only failing ones?
Only failing ones. HBOT is not used after routine successful surgery. It’s an intervention for grafts or flaps that show signs of compromise — poor color, slow capillary refill, tissue breakdown, or signs of infection.
How does HBOT help a failing skin graft?
Failing grafts are often hypoxic — they’re not getting enough oxygen to survive. HBOT saturates blood plasma with dissolved oxygen, pushing it into tissue even where circulation is limited. It also stimulates new blood vessel growth, which helps the graft bed develop the supply network the graft needs.
Does insurance cover HBOT for skin grafts?
Insurance may cover HBOT for compromised grafts and flaps. It’s an approved indication under Medicare and recognized by the Undersea and Hyperbaric Medical Society. Coverage depends on your specific plan and documentation of graft compromise. Confirm with your insurer before scheduling.
How many HBOT sessions are needed after a skin graft?
Typical protocols for compromised grafts and flaps run 20 to 30 sessions at 2.0 to 2.4 ATA. The exact number depends on graft response and the severity of compromise.
References
Boykin, J.V. Jr. (1996). The nitric oxide connection: hyperbaric oxygen therapy, wound repair, and implications for limb salvage. PMID: 8662569. https://pubmed.ncbi.nlm.nih.gov/8662569/
Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.