Vishvanath

No useful evidence that hyperbaric oxygen influences the outcome of free vascularised flap surgery

 

Clinical Bottom Line: 1. No advantage was evident with the addition of postoperative hyperbaric oxygen

Citation/s:1.Capt Vishvanath G. Hyperbaric oxygen therapy in free flap surgery: is it meaningful?. Medical Journal Armed Forces India. 2011 Jul 1;67(3):253-6.
 

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Lead author's name and fax: G Vishvanath: caddie_afmc@yahoo.co.in

Three-part Clinical Question:For patients undergoing vascularised free flap procedures, does the addition of a course of hyperbaric oxygen to the usual care result in any improved outcomes?
Search Terms: Plastic surgery, free flap, surgical wound healing

The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Patients undergoing free tissue flap procedures with microvascular repair.
Control group (N = 5; 5 analysed): All usual postoperative care.
Experimental group (N = 5; 5 analysed): As above but breathed 100% oxygen at 2.5 ATA daily for seven days postoperatively.

The Evidence:

Outcome	Time to Outcome	Control group	HBOT group	Relative risk reduction	Absolute risk reduction	NNT
Flap loss	14 days	0.2	0.2	0%	0.0	INF
	95% CIs:			-248% to 100%	-0.5 to 0.5	NNT = 2 to INF; NNH = 2 to INF

 

Measure	Control Group		HBOT Group		Difference	95% CI
	Mean	SD	Mean	SD
Days to resolution of oedema	2.5		2.0		0.5	-
Days to resolution of venous congestion	0.5		0.25		0.25	-
Days to complete epithelialisation	8.75		8.5		0.25	-

Comments:
1. Very small study with low power to detect important differences. Authors made conclusions without any statistical analysis. No description of sample size calculation.
2. It is not clear if the surgeons were aware of allocation at the time of surgery.
3. One participant in each group was excluded because of gross flap failure within 24 hours (before any HBO administered).

Appraised by: Mike Bennett POWH m.bennett@unsw.edu.au; Wednesday, 29 September 2021
Kill or Update By: September 2025