TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summary below includes the Background and Best Practice sections of the original article. To view the complete Laryngoscope article free of charge, visit Laryngoscope.
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October 2022BACKGROUND
Hyperbaric oxygen therapy (HBOT) can be used to help treat an ischemic skin flap. Proponents claim that HBOT is a potential adjunctive modality to help salvage an arterial compromised skin flap by reducing its hypoxic injury, stimulating angiogenesis, and improving fibroblast function for collagen formation. Specifically, HBOT involves subjecting a patient to 100% oxygen at elevated atmospheric pressure for several sessions. Unfortunately, it remains unclear what level of evidence supports HBOT for treating an ischemic skin flap. Furthermore, it is undetermined which skin flap patients should undergo HBOT, when it should be initiated, and the treatment duration. Here, authors describe the current literature to determine the effectiveness of HBOT on vascular compromised local/regional skin flaps.
BEST PRACTICE
For an ischemic compromised skin flap, HBOT can be considered as a possible adjunctive therapy and should be implemented within 48 hours. Unfortunately, no consistent HBOT protocols have been firmly established (optimal dive sessions, session duration, and atmospheres delivered) to maximize flap survival. Future studies are needed to provide multicenter prospective clinical studies comparing HBOT to other adjunctive modalities in the treatment of ischemic skin flaps. The studies included one level 1 article, two level 2 articles, one level 3 study, and one level 4 study.