Perrins

Hyperbaric oxygen improved the percentage of take in split-thickness skin grafts after thermal burns.

Clinical Bottom Line: 1. The percentage of graft take was significantly higher when treatment included hyperbaric oxygenation. 2. Total or near total take was achieved in 64% of hyperbaric treated grafts.

• • Appraised by:Mike Bennett, Prince of Wales Hospital, Dept. of Diving and Hyperbaric Medicine

Sydney; Wednesday, December 02, 1998

• • Clinical Scenario:A patient with full-thickness burns to a limb and requiring skin grafts.
  • Three-part Question:In patients with full-thickness thermal burns requiring skin grafts, does the application of hyperbaric oxygen compared to normal post-graft care, result in any increased graft survival?
  • Search Terms:hyperbaric oxygenation, burn/thermal, skin graft.

• • The Study:

Single-blinded randomized controlled trial with intention-to-treat. Patients with burns presenting for split thickness skin grafting. Control group (N = 24; 24 analysed): Split-thickness skin grafting to the burn area, suitable and closed dressings of paraffin gauze, cotton wool and bandages. No sham treatment. Experimental group (N = 24; 24 analysed): As above plus oxygen at 2ATA for 2 hours that evening and twice daily for three days.

• • The Evidence:

Outcome	Time to Outcome	Control	HBO	Relative risk reduction	Absolute risk reduction	NNT
>95% graft take	3 days	0.167	0.63	277%	0.46	2
95% CI				100% to 131%	0.22 to 0.71	1 to 5
>60% graft take	3 days	0.625	1.0	60%	0.38	3
95% CI				29% to 91%	0.18 to 0.57	2 to 6

Expiry date:July 2021Comments: 1. Only the operator was blind to treatment allocation. 2. Randomization process not defined. 3. Now over thirty years since trial and current success rate of grafts may be important in interpretation. 4. No indication of the distribution of confounders given.

• • References:

1. Perrins DJD. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet 1967; 7495:868-871.

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