Reconstructive surgery often depends on a skin graft or flap successfully "taking" — meaning the transferred tissue reconnects with a healthy blood supply and survives. Most of the time, this goes smoothly. But when a graft or flap doesn't receive enough oxygen-rich blood, it can become compromised, putting the results of surgery, and sometimes the tissue itself, at risk.

Hyperbaric oxygen therapy (HBOT) is one of a small number of treatments recognized as an FDA-approved indication for exactly this problem.

Why Grafts and Flaps Become Compromised

Skin grafts and flaps depend on new blood vessel connections to survive. According to a clinical review published through the National Center for Biotechnology Information (NCBI), several factors can interfere with that process, including prior radiation exposure, poor circulation at the wound site, tension on the tissue's blood supply, and low oxygen levels in the wound bed. When perfusion is compromised, the tissue is at risk of dying, which can mean additional surgery and longer recovery.

What the Research Shows

The Undersea and Hyperbaric Medical Society (UHMS), which sets clinical standards for hyperbaric medicine, has noted that HBOT is especially useful for salvaging tissue compromised by radiation damage or reduced blood flow, helping maximize the chances that a graft or flap survives without needing to be redone.

A review published in Advances in Wound Care examined the mechanisms behind this benefit, finding that HBOT supports graft and flap survival by increasing oxygen delivery to marginal tissue, improving the function of repair cells, encouraging new blood vessel growth, and reducing damage that can occur when blood flow returns to oxygen-starved tissue.

Clinical outcomes research backs this up. A study published in Plastic and Reconstructive Surgery found that flap survival rates improved substantially when hyperbaric oxygen was used alongside standard surgical care, particularly in cases involving poor circulation or prior radiation. Research reviewed by the NCBI also points to earlier initiation of HBOT, as soon as compromise is identified, as a key factor in maximizing tissue viability.

What This Means for Patients

HBOT is not used for grafts and flaps healing normally — its FDA-approved role is specifically for tissue showing signs of poor blood flow, tissue death, or delayed healing after surgery. For patients recovering from procedures such as breast reconstruction, skin cancer removal, trauma repair, or flap-based reconstruction, HBOT offers a non-surgical option to support tissue survival when complications develop. Sessions involve breathing concentrated oxygen inside a pressurized chamber, allowing oxygen to reach compromised tissue even when normal blood flow is limited.

Safety and Expert Care

As an FDA-approved indication, HBOT for compromised grafts and flaps is backed by decades of clinical research and is typically covered by Medicare and many private insurance plans when medical necessity is documented. At Bay Area Hyperbarics, treatment is provided under expert care, with a focus on patient safety at every stage.

Consult a healthcare provider before starting any new treatment. This article is for educational purposes and does not replace medical advice from your surgical or care team.

If you or a loved one is recovering from surgery and a graft or flap isn't healing as expected, reach out to our team to learn whether hyperbaric oxygen therapy may help.