title: The application of hyperbaric oxygen therapy in the management of compromised flaps.
abstract: BACKGROUND
  Hyperbaric oxygen (HBO2) therapy has been used to promote viability of compromised flaps despite a paucity of supportive clinical evidence. This study provides an in-depth characterization of hyperbaric medicine to promote flap survival and identifies treatment variables associated with positive clinical outcomes.
  
  
  METHODS
  A retrospective review was conducted of patients who received HBO2 therapy for a failing or threatened post-reconstructive flap from 5/30/2008 through 4/30/2012. Medical records were reviewed to collect patient characteristics, hyperbaric oxygen therapy details, and clinical outcomes. Descriptive and comparative statistics were utilized.
  
  
  RESULTS
  Ninety-one patients underwent HBO2 therapy during this time period, with 15 patients meeting the selection criteria. Flap survival was achieved in 11 patients (73.3%). Of those successfully treated, four (36.4%) healed completely, and seven (63.6%) demonstrated marked improvement. Patients who were treated successfully demonstrated an average improvement in flap area of 68.3%. Variables significantly associated with a favorable treatment outcome included a high percentage of treatment completion (p = 0.022) and high pretreatment transcutaneous oxygen measurements (p = 0.05). Smoking was a negative factor (p = 0.011).
  
  
  CONCLUSIONS
  This study provides clinical data characterizing and supporting the application of hyperbaric medicine to aid in the viability of compromised flaps.
authors.affiliation: College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Larson
authors.affiliation: Western Michigan University School of Medicine, Department of Surgery, Kalamazoo, MI, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Steensma
authors.affiliation: Western Michigan University School of Medicine, Department of Surgery, Kalamazoo, MI, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Flikkema
authors.affiliation: Western Michigan University School of Medicine, Department of Surgery, Kalamazoo, MI, USA.
authors.forename: Earl M
authors.initials: EM
authors.lastname: Norman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013524:Surgical Flaps / Q000502:physiology*; D055815:Young Adult