Hyperbaric Oxygen Therapy (HBOT) versus Standard Wound Care in Rescue of Compromised Skin Flap or Graft Reconstruction Following Resection of Cutaneous and Head and Neck Malignancy: A Systematic Review and Meta-Analysis

Summary: Hyperbaric oxygen therapy (HBOT) is an FDA-approved intervention for compromised skin flaps/grafts. However, its use among reconstructive surgeons for compromised flaps/grafts following a cutaneous or head and neck (H&N) malignancy resection is rare. Therefore, this study aims to assess the role of HBOT in salvaging compromised flaps/grafts following skin and H&N cancer resections and provides data that may guide clinical practice. A systematic review with meta-analysis was conducted across PubMed, Ovid MEDLINE, Scopus, Cochrane Library, and CINAHL databases. Keywords focused on cutaneous and H&N carcinoma, HBOT, and compromised skin grafts/flaps. Fifty-four studies were included, encompassing 454 compromised flaps/grafts divided into HBOT (36) and non-HBOT (418) groups. The flap/graft loss rates were 50.95% for the non-HBOT group and 16.57% for the HBOT group. Chi-squared tests indicated significant benefits of HBOT in graft/flap salvage. Fisher’s Exact test found no significant association between HBOT and the extent of flap/graft failure (partial vs. complete). Evidence suggests that HBOT is advantageous over non-HBOT treatments for salvaging compromised grafts/flaps after skin and H&N cancer resections, although its effect on the severity of flap/graft failure is not significant.