Background: Hyperbaric oxygen therapy (HBOT) has shown potential in salvaging compromised flaps, although its application has primarily been focused on local flaps rather than free flaps.
Case: In this case report, we present the successful use of HBOT in a 76-year-old man who underwent free flap reconstruction for calcaneal osteomyelitis. Despite undergoing 2 reoperations on the second and third days post reconstruction, no thrombosis was observed at the anastomotic site. Following the second reoperation, HBOT was promptly initiated and continued for a total of 9 sessions. Notably, after the sixth HBOT session, fresh bleeding occurred upon flap puncture. Eventually, the flap developed epidermal necrosis, which was conservatively treated.
Discussion: It is crucial to first rule out mechanical causes of compromised free flaps through surgical exploration, with HBOT serving as an adjunctive rather than a primary treatment option--even considered as the last resort. Nevertheless, in cases where mechanical causes have been ruled out, HBOT may significantly enhance flap survival rates in compromised free flaps.
Keywords: Compromised Flap; Free Flap; Hyperbaric Oxygen Therapy; Salvage.
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