RevitalizeMe
Hyperbaric Oxygen & Wound Care
3200 Cabaret Trail S., Suite 3 | Saginaw, MI 48603
(989) 320-4434 | HyperbaricWoundCare.com
(989) 320-4434 | HyperbaricWoundCare.com
Clinical Evidence Summary
Compromised Skin Grafts & Flaps — HBOT
FDA & CMS Approved
| Medicare & Medicaid Covered
64%
Greater split-thickness graft survival with adjunctive HBOT
Perrins DJ, Lancet 1967
Early
Initiate HBOT immediately when duskiness or ischemia appears post-op
Zamboni et al., Plast Reconstr Surg
20–30
HBOT sessions in standard CMS protocol for compromised grafts/flaps
CMS Coverage Policy NCD 20.29
Any Amp
TMA, toe amp, ray amp — flap documented in op note qualifies
CMS Coverage Criteria
Clinical Overview
Compromised skin grafts and flaps share a common mechanism of failure: inadequate oxygen delivery to the wound margin during the critical period of revascularization. Whether due to radiation history, vascular disease, infection, or technical factors, tissue at the flap margin becomes hypoxic and undergoes progressive necrosis without intervention. HBOT creates a steep oxygen diffusion gradient that sustains graft and flap survival while new vasculature develops — functioning as a bridge to permanent revascularization.
Key Published Evidence
Lancet — Landmark Randomized Trial
Perrins conducted one of the first RCTs of HBOT in surgery, demonstrating that HBOT-treated split-thickness grafts showed 64% greater survival compared to controls. This landmark study established the biological rationale for HBOT in graft salvage and remains foundational in the literature.
Perrins DJ. Lancet. 1967;1(7495):672–673.
Plastic & Reconstructive Surgery — Experimental Study
Zamboni et al. demonstrated that HBOT significantly reduced the zone of necrosis in ischemic flap models, preserving marginal flap viability through sustained high oxygen delivery during the critical period before neovascularization is established.
Zamboni WA, et al. Plast Reconstr Surg. 1995;96(2):534–535.
Podiatry Note — Post-Amputation Flaps
Any amputation — TMA, toe, partial ray — with a flap documented in the operative note qualifies for HBOT if the post-op visit shows duskiness, ischemia, dehiscence, or compromise. You do not need to bill the flap — documentation is sufficient for coverage. We handle all prior authorization.
CMS National Coverage Determination 20.29
How HBOT Works
1
Delivers dissolved oxygen directly to hypoxic flap margins — independent of hemoglobin
2
Stimulates angiogenesis and capillary ingrowth into the ischemic zone
3
Reduces post-ischemic reperfusion injury and inflammatory edema
4
Enhances fibroblast activity and collagen synthesis at the graft interface
Ideal Referral Candidate
Any post-op flap or graft showing duskiness, ischemia, or marginal necrosis
Post-amputation wound (TMA, toe, ray) with flap in op note showing compromise
Free flap reconstruction in previously irradiated tissue bed
Split-thickness or full-thickness graft with poor or delayed take
Diabetic or vascular patient with high-risk wound closure
Standard HBOT Protocol
Pressure
2.0–2.4 ATA
Duration
90 min/session
Sessions
20–30 dives
Timing
Initiate early