Oxigenoterapia Hiperbarica para ayudar con
Injertos, flaps y Colgajos Comprometidos
¿CON QUE PUEDE AYUDAR LA CÁMARA HIPERBÁRICA EN INJERTOS Y COLGAJOS COMPROMETIDOS?
La terapia de oxígeno hiperbárico (TOHB), usando presiones mayores a 2.0 ATA, se utiliza en casos de injertos y colgajos comprometidos para:
Aumento de oxígeno: Mejora el suministro de oxígeno a los tejidos en un entorno de alta presión, lo que favorece la curación.
Aumento de la vascularización: Estimula la formación de nuevos vasos sanguíneos, mejorando el flujo sanguíneo.
Reducción de la inflamación: Disminuye la inflamación local, facilitando la circulación.
Apoyo a la resistencia a infecciones: Refuerza el sistema inmunológico, reduciendo el riesgo de infecciones.
Promoción de la curación: Acelera el proceso de curación, permitiendo una regeneración más rápida de los tejidos.
LA TERAPIA HIPERBÁRICA PARA AYUDAR A SANAR INJERTOS O COLGAJOS COMPROMETIDOS
La terapia de oxígeno hiperbárico (TOHB) ha demostrado ser beneficiosa en la promoción de la curación de injertos y colgajos comprometidos. En estos procedimientos quirúrgicos, el suministro de oxígeno es esencial para garantizar la viabilidad de los tejidos trasplantados. La TOHB ofrece un ambiente enriquecido con oxígeno bajo presión, lo que aumenta significativamente la oxigenación de los tejidos afectados. Esto estimula la formación de nuevos vasos sanguíneos, acelera la regeneración del tejido y fortalece el sistema inmunológico, reduciendo el riesgo de infecciones. En última instancia, la TOHB mejora la tasa de éxito de los injertos y colgajos, promoviendo una recuperación más rápida y efectiva
¿CUÁNTAS SESIONES SE NECESITAN?
La cantidad de sesiones de terapia de oxígeno hiperbárico (TOHB) recomendadas para injertos y colgajos comprometidos puede variar según la gravedad del caso y la respuesta del paciente. Por lo general, se recomienda un curso de varias sesiones, que suele ser de 20 a 40 sesiones, usando presiones de 2.0 ATA, administradas a lo largo de varias semanas. Incluso si se toman 10-20 sesiones antes de la intervención quirúrgica y el resto después de la intervención, aumenta el porcentaje de sobrevivencia del tejido. Sin embargo, no hay que olvidar, la decisión final sobre la cantidad de sesiones y la duración del tratamiento se basará en la evaluación de tu médico tratante, quien considerará las necesidades específicas del paciente y la evolución de su condición. Es importante seguir las recomendaciones de su médico para obtener los mejores resultados.
CÓMO SIRVE LA TERAPIA EN CÁMARA HIPERBÁRICA PARA INJERTOS Y COLGAJOS COMPROMETIDOS
Mas detallado con estudios de soporte usando presiones arriba de 2.0 ATA
Investigaciónes y Fuentes
Liceaga, D. E. (2014). GUÍAS CLÍNICAS DE DIAGNÓSTICO Y TRATAMIENTO DEL SERVICIO DE CÁMARA HIPERBÁRICA. Ciudad de Mexico: Hospital General de Mexico.
Undersea and Hyperbaric Medical Society. (2021). Indications for Hyperbaric Oxygen Therapy. Retrieved from https://www.uhms.org/resources/hbo-indications.html
Chapter 5: The Effect of Hyperbaric Oxygen on Compromised Grafts and Flaps
Shawna Kleban MD, Richard C. Baynosa MD (corresponding author)
REFERENCES
1. Francis A, Baynosa RC. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap. Adv Wound Care (New
Rochelle). 2017 Jan 1;6(1):23-32.
2. Francis A, Baynosa RC. Ischaemia-reperfusion injury and hyperbaric oxygen pathways: a review of cellular
mechanisms. Diving Hyperb Med. 2017 Jun;47(2):110-117.
3. Kivisaari J, Niinikoski J. Effects of hyperbaric oxygen and prolonged hypoxia on the healing of open wounds. Acta
Chir Scand. 1975;141:14-19.
4. Shulman AG, Krohn HL. Influence of hyperbaric oxygen and multiple skin allografts on the healing of skin
wounds. Surgery. 1967;62:1051-1058.
5. Erdmann D, Roth AC, Hussmann J, et al. Skin allograft rejection and hyperbaric oxygen treatment in
immunohistocompatible mice. Undersea Hyperbaric Med. 1995;22: 395-399.
6. Erdmann D, Roth AC, Hussman J, et al. Hyperbaric oxygen and cyclosporine as a combined treatment regimen to
prevent skin allograft rejection in immunohistocompatible mice. Ann Plast Surg. 1996;36:304-308.
7. Renner G, McClane SD, Early E, et al. Enhancement of auricular composite graft survival with hyperbaric oxygen
therapy. Arch Facial Plast Surg. 2002;4:102-104.
8. Rubin JS, Marzella L, Myers RA, et al. Effects of hyperbaric oxygen on the take of composite skin grafts in rabbit
ears. J Hyperbaric Med. 1988;3:79-88.
9. Zhang F, Cheng C, Gerlach T, et al. Effect of hyperbaric oxygen on survival of the composite ear graft in rats. Ann
Plast Surg. 1998;41:530-534.
10. Li EN, Menon NG, Rodriguez ED, et al. The effect of hyperbaric oxygen therapy on composite graft survival. Ann
Plast Surg. 2004; 53:141-145.
11. Fodor L, Ramon Y, Meilik B, et al. Effect of hyperbaric oxygen on survival of composite grafts in rats. Scand J Plast
Reconstr Surg Hand Surg. 2006;40:257-260.
12. Kernahan KA, Zingg W, Kay CW. The effect of hyperbaric oxygen on the survival of experimental skin flaps. Plast
Reconstr Surg. 1965;36:19-25.
13. McFarlane RM, DeYoung G, Henry RA. Prevention of necrosis in experimental pedicle flaps with hyperbaric
oxygen. Surg Forum. 1965;6:481-482.
14. Wald HI, Georgiade NG, Angelillo J, et al. Effect of intensive hyperbaric oxygen therapy on the survival of
experimental skin flaps in rats. Surg Forum. 1968;19:497-499.
15. Niinikoski J. Viability of ischemic skin in hyperbaric oxygen. Acta Chir Scand. 1970: 136: 567-568.
16. Gruber RP, Heitkamp DH, Lawrence JB. Skin permeability to oxygen and hyperbaric oxygen. Arch Surg.
1970;101:69-70.
17. Pellitteri PK, Kennedy TL, Youn BA. The influence of intensive hyperbaric oxygen therapy on skin flap survival in a
swine model. Arch Otolaryngol Head Neck Surg. 1992;118:1050-1054.
18. Arturson GG, Khanna NN. The effects of hyperbaric oxygen, dimethyl sulfoxide and complamin on survival of
experimental skin flaps. Scand J Plast Reconstr Surg. 1970;4:8-10.
19. Esclamado RM, Larrabee WF Jr, Zel GE. Efficacy of steroids and hyperbaric oxygen on survival of dorsal skin flaps
in rats. Otolaryngol Head Neck Surg. 1990;102:41-44.
20. Stewart RJ, Moore T, Bennett B, et al. Effect of free-radical scavengers and hyperbaric oxygen on random-pattern
skin flaps. Arch Surg. 1994;129:982-987.
21. Da Rocha FP, Fagundes DJ, Rivoire HC, et al. Immunohistochemical expression of apoptosis and VEGF expression
on random skin flaps in rats treated with hyperbaric oxygen and N-acetylcysteine. Undersea Hyperbaric Med.
2011;38:167-174.
22. Da Rocha FP, Fagundes DJ, Pires JA, et al. Effects of hyperbaric oxygen and N-acetylcysteine in survival of random
pattern skin flaps in rats. Indian J Plast Surg. 2012;45:453-458.
23. Greenwood TW, Gilchrist AG. The effect of HBO on wound healing following ionizing radiation. In: Trapp WC,
et al., Eds. Proceedings of the fifth international congress on hyperbaric medicine, Vol I. Barnaby, Canada: Simon
Fraser University. 1973;253-263.
24. Nemiroff PM, Merwin GE, Brant T, et al. HBO and irradiation on experimental skin flaps in rats. Surg Forum.
1984;35:549-550.
25. Nemiroff PM, Merwin GE, Brant, et al. Effects of hyperbaric oxygen and irradiation on experimental flaps in rats.
Otolaryngol Head Neck Surg. 1985;93: 485-491.
26. Zhang T, Gong W, Li Z, et al. Efficacy of hyperbaric oxygen on survival of random pattern skin flap in diabetic rats.
Undersea Hyperbaric Med. 2007;335-339.
Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.
27. Selcuk CT, Kuvat SV, Bozkurt M, et al. The effect of hyperbaric oxygen therapy on the survival of random pattern
skin flaps in nicotine-treated rats. J Plast Reconstr Aesthet Surg. 2012;65:489-493.
28. Demirtas A, Azbo I, Bulut M, et al. Effect of hyperbaric oxygen therapy on healing in an experimental model of
degloving injury in tails of nicotine-treated rats. J Hand Surg Eur Vol. Epub ahead of print. 2012 Dec 7.
29. Nemiroff PM, Lungu AL. The influence of hyperbaric oxygen and irradiation on vascularity in skin flaps: a
controlled study. Surg Forum. 1987;38:565-567.
30. Manson PN, Im MJ, Myers RA, et al. Improved capillaries by hyperbaric oxygen in skin flaps. Surg Forum.
1980;31:564-566.
31. Hartwig J, Kohnlein HE. The influence of hyperbaric oxygen therapy and Dextran 40 on wound healing. Eur Surg
Res. 5(Suppl). 1973:109.
32. Meltzer T, Myers B. The effect of hyperbaric oxygen on the bursting strength and rate of vascularization of skin
wounds in rats. Am Surg. 1986;52: 659-662.
33. Marx RE and Ames JR. The use of hyperbaric oxygen therapy in bony reconstruction of the irradiated and tissue
deficient patient. J Oral Maxillofac Surg. 1982;40: 412-420.
34. Champion WM, McSherry CK, Goulian D. Effect of hyperbaric oxygen on survival of pedicled skin flaps. J Surg
Res. 1967;7:583-586.
35. McFarlane RM, Wermuth RE. The use of hyperbaric oxygen to prevent necrosis in experimental pedicle flaps and
composite skin grafts. Plast Reconstr Surg. 1966;37:422-430.
36. Jurell G, Kaijser L. The influence of varying pressure and duration of treatment with hyperbaric oxygen on the
survival of skin flaps: an experimental study. Scand J Plast Reconstr Surg. 1973;7:25-28.
37. Tan CM, Im MJ, Myers RA, et al. Effect of hyperbaric oxygen and hyperbaric air on survival of island skin flaps.
Plast Reconstr Surg. 1974;73:27-30.
38. Ramon Y, Abramovich A, Shupak A, et al. Effect of hyperbaric oxygen on a rat transverse rectus abdominis
myocutaneous flap model. Plast Reconstr Surg. 1998:102;416-422.
39. Prada FS, Arrunategui G, Alves MC, et al. Effect of allopurinol, superoxide-dismutase, and hyperbaric oxygen on
flap survival. Microsurg. 2002;22;352-360.
40. Nemiroff PM. Synergistic effects of pentoxifylline and hyperbaric oxygen on skin flaps. Arch Otolaryngol Head
Neck Surg. 1988;114:977-981.
41. Collins TM, Caimi R, Lynch PR, et al. The effects of nicotinamide and hyperbaric oxygen on skin flap survival.
Scand J Plast Reconstr Surg Hand Surg. 1991;25:5-7.
42. Lozano DD, Stephenson LL, Zamboni WA. Effect of hyperbaric oxygen and medicinal leeching on survival of axial
skin flaps subjected to total venous occlusion. Plast Reconstr Surg. 1999;104:1029-1032.
43. Yucel A, Bayramicli. Effects of hyperbaric oxygen treatment and heparin on the survival of unipedicled venous flaps:
and experimental study in rats. Ann Plast Surg. 2000;295-303.
44. Ulkur E, Yuksel F, Acikel C, et al. Effect of hyperbaric oxygen on pedicle flaps with compromised circulation.
Microsurg. 2002;22:; 16-20.
45. Zamboni WA, Roth AC, Russell RC, et al. The effect of acute hyperbaric oxygen therapy on axial pattern skin flap
survival when administered during and after total ischemia. J Reconstr Microsurg. 1989;5:343-347.
46. Zamboni WA, Roth AC, Russell RC, et al. The effect of hyperbaric oxygen on reperfusion of ischemic axial skin
flaps: a laser Doppler analysis. Ann Plast Surg. 1992;28:339-341.
47. Kaelin CM, Im MJ, Myers RA, et al. The effects of hyperbaric oxygen on free flaps in rats. Arch Surg.
1990;125:607-609.
48. Zamboni WA, Roth AC, Russell RC, et al. Morphological analysis of the microcirculation during reperfusion of
ischemic skeletal muscle and the effect of hyperbaric oxygen. Plast Reconstr Surg. 91. 1993;1110-1123.
49. Jones SR, Carpin KM, Woodward SM, et al. Hyperbaric oxygen inhibits ischemia-reperfusion-induced CD18
neutrophil polarization by a nitric oxide mechanism. Plast Reconstr Surg. 2010:126:403-411.
50. Baynosa RC, Naig AL, Murphy PS, et al. The effect of hyperbaric oxygen on nitric oxide synthase activity and
expression in ischemia-reperfusion injury. J Surg Res. Epub ahead of print. 2013 Feb 1.
51. Francis A, Kleban SR, Stephenson LL, et al. Hyperbaric Oxygen Inhibits Reperfusion-Induced Neutrophil
Polarization and Adhesion Via Plasmin-Mediated VEGF Release. Plast Reconstr Surg Glob Open. 2017 Sep
25;5(9):e1497.
52. Hong JP, Kwon H, Chung YK, et al. The effect of hyperbaric oxygen on ischemia-reperfusion injury: an
experimental study in a rat musculocutaneous flap. Ann Plast Surg. 2003;51:478-487.
53. Tomur A, Etlik O, Gundogan NU. Hyperbaric oxygenation and antioxidant vitamin combination reduces ischemiareperfusion injury in a rat epigastric island skin-flap model. J Basic Clin Physiol Pharmacol. 2005;16: 275-285.
Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.
54. Stevens DM, Weiss DD, Koller WA, et al. Survival of normothermic microvascular flaps after prolonged secondary
ischemia: Effects of hyperbaric oxygen. Otolaryngol Head Neck Surg. 115: 360-364, 1996.
55. Wong HP, Zamboni WA, Stephenson LL. Effect of hyperbaric oxygen on skeletal muscle necrosis following primary
and secondary ischemia in a rat model. Surg Forum. 1996;47:705-707.
56. Gampper TJ, Zhang F, Mofakhami NF, et al. Beneficial effect of hyperbaric oxygen on island flaps subjected to
secondary venous ischemia. Microsurg. 2002;22:49-52.
57. Perrins DJD. Hyperbaric oxygenation of skin flaps. Br J Plast Surg. 1966;19:110-112.
58. Perrins DJD, Cantab MB. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet. 1967;1: 868-
871.
59. Roje Z, Roje Z, Eterovic D et al. Influence of adjuvant hyperbaric oxygen therapy on short-term complications
during surgical reconstruction of upper and lower extremity war injuries: retrospective cohort study. Croat Med J.
2008;49:224-232.
60. Gonnering RS, Kindwall EP, Goldmann RW. Adjunct hyperbaric oxygen therapy in periorbital reconstruction. Arch
Opthalmol. 1986;104: 439-443.
61. Bowersox JC, Strauss MB, Hart GB. Clinical experience with hyperbaric oxygen therapy in salvage of ischemic skin
flaps and grafts. J Hyperbaric Med. 1986; 141-149.
62. Friedman HI, Stonerock C, Brill A. Composite earlobe grafts to reconstruct the lateral nasal ala and sill. Ann Plast
Surg. 2003;3:275-281.
63. Qing Y, Cen Y, Chen J, Ke S. Reconstruction of a large through-and-through defect of the nasal tip using a modified
auricular composite graft. J Craniofac Surg. 2015;26:382-383.
64. Saber AA, Yahya KZ, Rao A, et al. A new approach in the management of chronic nonhealing leg ulcers. J Invest
Surg. 2005;18: 321-323.
65. Assaad NN, Chong R, Tat LT, et al. Adjuvant hyperbaric oxygen therapy to support limbal conjunctival graft in the
management of recurrent pterygium. Cornea. 2011;30:7-10.
66. Ueda M, Kaneda T, Takahashi H, et al. Hyperbaric oxygen therapy of ischemic skin flaps: clinical and experimental
study. Proceedings of 9th International Symposium on Underwater Hyperbaric Physiology. Undersea & Hyperbaric
Medical Society. 1987;823.
67. Mathieu D, Neviere R, Pellerin P, et al. Pedicle musculocutaneous flap transplantation: Prediction of final outcome
by transcutaneous oxygen measurements in hyperbaric oxygen. Plast Reconstr Surg. 1993;91: 329-334.
68. Waterhouse MA, Zamboni WA, Brown RE, et al. The use of HBO in compromised free tissue transfer and
replantation, a clinical review. Undersea Hyperbaric Med.1993; 20(Suppl):64.
69. Larson JV, Steensma EA, Flikkema RM, Norman EM. The application of hyperbaric oxygen therapy in the
management of compromised flaps. Undersea Hyperb Med. 2013;40:499-504.
70. Skeik N, Porten BR, Isaacson E, et al. Hyperbaric oxygen treatment outcome for different indications from a single
center. Ann Vasc Surg 2015; 29:206-214.
71. Nichter LS, Morwood DT, Williams GS, et al. Expanding the limits of composite grafting: a case report of
successful nose replantation assisted by hyperbaric oxygen therapy. Plast Reconstr Surg. 1991;87: 337-340.
72. Rapley JH, Lawrence WT, Witt PD. Composite grafting and hyperbaric oxygen therapy in pediatric nasal tip
reconstruction after avulsive dog-bite injury. Ann Plast Surg. 2001;46: 434-438.
73. Cantarella G, Mazzola RF and Pagani D. The fate of an amputated nose after replantation. Am J Otolaryngol.
2005;26: 344-347.
74. Pou JD, Graham HD. Pediatric Nasal Tip Amputation Successfully Treated with Nonmicrovascular Replantation
and Hyperbaric Oxygen Therapy. Ochsner J. 2017 Summer;17(2):204-207.
75. McCrary BF. Hyperbaric oxygen treatment for a failing facial flap. Postgrad Med J. 2007;83: e1-e3.
76. Khandelwal S, Wall J, Kaide C, et al. Case report: successful use of hyperbaric oxygen therapy for a complete scalp
degloving injury. Undersea Hyperbaric Med. 2008;35: 441-445.
77. Mermans JF, Tuinder S, von Meyenfeldt MF, et al. Hyperbaric oxygen treatment for skin flap necrosis after a
mastectomy: a case study. Undersea Hyperbaric Med. 2012;39:719-723.
78. Fredman R, Wise I, Friedman T, Heller L, Kami T. Skin-sparing mastectomy flap ischemia salvage using urgent
hyperbaric chamber oxygen therapy: a case report. Undersea Hyperb Med 2014;41:145-147.
79. Copeland-Halperin LR, Bruce SR, Mesbahi AN. Hyperbaric oxygen following bilateral skin-sparing mastectomies: a
case report. Plast Reconstr Surg Glob Open. 2016;4:e680.
80. Zhou YY, Liu W, Yang YJ, Lu GD. Use of hyperbaric oxygen on flaps and grafts in China: analysis of studies in the
past 20 years. Undersea Hyperb Med. 2014;41:209-216.
81. Baynosa RC and Zamboni WA. Compromised grafts and flaps. In: TS Neuman & SR Thom, Eds. Physiology and
Medicine of Hyperbaric Oxygen Therapy. Philadelphia, PA: Saunders/Elsevier. 2008; 373-395.
Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.
82. Friedman HI, Fitzmaurice M, Lefaivre JF, et al. An evidence-based appraisal of the use of hyperbaric oxygen on flaps
and grafts. Plast Reconstr Surg. 2006;117 (Suppl):175S-190S.
83. Nemiroff PM, Rybak LP. Applications of hyperbaric oxygen for the otolaryngologist-head and neck surgeon. Am J
Otolaryngol. 1988;9:52-57.
84. Reinisch JF. Pathophysiology of skin flap circulation: The delay phenomenon. Plast Reconstr Surg. 1974;54:585-
598.
85. Reinisch JF. The role of arteriovenous anastomosis in skin flaps. In: Grabb WC, Myers MBG, Eds. Skin Flaps.
Boston, MA: Little Brown & Co. 1975;81-92.
86. Weber R, Silver A, Williams SJ, et al. Random flap survival with hyperbaric oxygen: daily versus twice-daily
treatments. Undersea Hyperb Med. 2018 Mar-Apr;45(2):157-164