Asia
Hyperbaric
Centre
Who Is
This For?
This supportive protocol is for people recovering from reconstructive or plastic surgery whose grafted or transferred tissue is at risk of failing. It is also for those whose surgical team wants to prepare a high-risk wound bed before reconstruction.
It is most appropriate for:
Post-surgical salvage: Your surgeon has noticed signs that your skin graft, pedicle flap, or free flap is compromised — discolouration, poor capillary refill, coolness, or swelling beyond expectation — and has recommended hyperbaric oxygen as an adjunct to surgical care.
High-risk reconstructions: Your reconstruction involves tissue with known risk factors — a previously irradiated field, diabetes, vascular disease, smoking history, or a prior failed covering procedure — and your team wants every available advantage [3].
Complex reattachments: Reimplanted or reattached tissue (fingers, ear, nose, or other composite tissue) where salvage is critical and every hour of hypoxia matters.
This protocol is not for routine, healthy grafts — modern surgical technique handles those well. It exists for the cases where the tissue, or the wound bed beneath it, is already fighting uphill. A doctor's referral is required before any protocol begins. In salvage situations, we prioritise urgent referrals.
For compromised grafts and flaps, timing is not a detail. It is the intervention. The evidence consistently shows that hyperbaric oxygen works best when started early — ideally within 72 hours of surgery or the first sign of compromise [1] [4]. Every day of delay is tissue that cannot be recovered.
You or your surgical team should consider hyperbaric oxygen when:
A graft or flap shows early signs of ischemia — duskiness, pallor, delayed capillary refill, or excessive swelling — in the days immediately after surgery.
A free flap has suffered an ischemia-reperfusion event, where tissue damage continues even after blood flow is technically restored [2].
You are scheduled for reconstruction in a high-risk tissue bed (irradiated, diabetic, or previously failed), where preparing the site before surgery can change the outcome [1] [3].
A graft has partially failed and your surgeon is weighing revision — stabilising the surviving tissue can reduce the size, or the need, of what comes next.
If you are reading this within days of your surgery and your surgeon agrees, contact us now. Salvage windows do not wait.
When to Consider HBOT
Why HBOT Works for Compromised Grafts & Flaps
A graft or flap fails for one fundamental reason: the tissue's oxygen demand exceeds what its fragile new blood supply can deliver. A skin graft has no vessels of its own for the first days. It survives purely on oxygen diffusing from the wound bed beneath it. A flap keeps some blood supply — but swelling, vasospasm, and ischemia-reperfusion injury can choke the micro-circulation exactly when the tissue is most vulnerable [2].
Breathing faster cannot fix this. Neither can pure oxygen at normal pressure. The red blood cells that carry oxygen cannot reach tissue whose micro-vessels are swollen shut.
Inside the chamber, we change the physics. At 2.0 to 2.5 ATA, 99.5% medical-grade oxygen dissolves directly into the blood plasma, bypassing red blood cells entirely [1]. This oxygen-saturated plasma does three things the failing tissue needs.
First, it diffuses into the threatened area even through swollen, sluggish micro-circulation. Cells on the margin stay alive.
Second, it reduces the oedema that was strangling those vessels. Oxygen-induced vasoconstriction acts on healthy tissue, cutting fluid leakage — while the plasma keeps delivering oxygen [2].
Third, it limits ischemia-reperfusion injury, the inflammatory cascade that can destroy a flap even after flow is restored, by reducing neutrophil adhesion and oxidative damage [2].
Then, over a course of sessions, come the two processes that make salvage permanent. Fibroblast activity and collagen synthesis rebuild structure. Angiogenesis gives the graft a blood supply of its own [1] [2].
The Science & Clinical Evidence
We do not make promises. The research does that. Compromised graft and flap salvage is an established UHMS indication for hyperbaric oxygen [1], supported by a randomized controlled trial, systematic reviews, and decades of surgical series.
The foundational randomized trial, published in The Lancet, assigned people receiving split-thickness skin grafts to hyperbaric oxygen or standard care [3]:
64% vs 17% — the rate of complete graft take (more than 95% of graft surface surviving) with hyperbaric oxygen versus standard care alone. — Perrins, The Lancet, 1967 [3]
The largest early clinical series followed 105 people with threatened grafts and flaps, most with serious risk factors for healing failure:
~90% — the proportion of threatened grafts and flaps salvaged with adjunctive hyperbaric oxygen, in a series where most cases carried serious risk factors for failure. — Bowersox, Strauss & Hart, Journal of Hyperbaric Medicine, 1986 [4]
More recent surgical data continues the pattern. A single-centre vascular series reported:
75.7% — successful salvage of failing grafts and flaps after an average of 30 hyperbaric sessions. — Skeik et al., Annals of Vascular Surgery, 2015 [5]
And a meta-analysis of 23 controlled clinical trials found graft and flap survival rates of 62.5–100% with hyperbaric oxygen versus 35.0–86.5% without — with the clearest benefit when sessions began within 72 hours of surgery [6].
Where we are honest with you: much of this evidence comes from surgical case series rather than large modern randomized trials, because randomising someone with a failing graft to no salvage attempt raises ethical problems [1]. The evidence base is strong enough for the UHMS to recognise the indication — and its limits are exactly why we say hyperbaric oxygen supports surgical care; it never replaces it.
Our protocols follow UHMS guidance for compromised grafts and flaps [1]. In salvage situations, the schedule is set by the tissue, not the calendar — and coordinated directly with your surgeon.
Oxygen Purity: 99.5% Medical-Grade Oxygen — pharmaceutical-grade purity certified under the Pharmacy and Poisons Ordinance (Cap. 138) [7].
Chamber Pressure: 2.0 to 2.5 ATA (Atmospheres Absolute) — the clinical pressure required to dissolve oxygen into plasma and perfuse compromised tissue [1].
Session Duration: 90 minutes at depth.
Frequency (acute salvage): Initially up to twice daily for the first critical days, then once daily as the graft or flap stabilises — the first 72 hours carry the most weight [1] [4].
Total Course: Typically 10 to 30 sessions, guided by your surgeon's assessment of graft take and tissue viability [5].
The Protocol
What To Expect
We understand that entering a hyperbaric chamber can feel unfamiliar. Our team is here to guide you through every step of the process, ensuring you feel comfortable, safe, and supported.
Step 1 — The Briefing & Preparation: Before your first session, our technician will walk you through the safety protocols. You will change into 100% cotton clothing (provided) to eliminate static risk. No electronics, watches, or oil-based cosmetics are allowed inside the chamber.
Step 2 — Pressurisation: As the chamber pressurises over 10-15 minutes, you will feel a sensation in your ears similar to descending in an airplane. Our technician will coach you on simple techniques to clear your ears. Once at depth (2.0-2.4 ATA), you will breathe 99.5% pure oxygen through a comfortable hood or mask. You can read, rest, or watch a screen during the 90-minute session.
Step 3 — Depressurisation & Next Steps: The chamber will slowly depressurise over 10-15 minutes. Once open, you can return to your normal daily activities immediately. Our technician will examine your wound site and coordinate with your primary wound care team to track your progress.
FAQ
How many sessions before I notice a difference?
In salvage cases, the tissue often answers within the first few sessions — colour, warmth, and capillary refill are watched closely by you and your surgical team. Most courses run 10 to 30 sessions. The early sessions protect what is threatened. The later ones build the circulation that makes the salvage permanent.
How quickly do I need to start?
As soon as your surgeon recommends it. The evidence is unambiguous on timing: outcomes are best when hyperbaric oxygen begins within 72 hours of surgery or the first sign of compromise [1] [4]. If you are inside that window now, contact us and your surgical team today. Urgent referrals are prioritised.
Will hyperbaric oxygen save my graft?
We cannot promise an outcome — no honest provider can. What the evidence shows is that adjunctive hyperbaric oxygen significantly improves the odds of salvage in compromised grafts and flaps, with the largest benefit when started early [3] [4] [5]. Some grafts cannot be saved by any means. Our role is to make sure oxygen is not the reason yours is lost.
UHMS. Compromised Skin Grafts and Flaps. UHMS Hyperbaric Oxygen Therapy Indications, 15th Edition. Undersea and Hyperbaric Medical Society. UHMS Official Indications
Francis A, Baynosa RC. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap. Adv Wound Care (New Rochelle). 2017;6(1):23-32. PMC5220535
Perrins DJ. Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet. 1967;1(7495):868-871. PubMed 4164367
Bowersox JC, Strauss MB, Hart GB. Clinical experience with hyperbaric oxygen therapy in the salvage of ischemic skin flaps and grafts. J Hyperbaric Med. 1986;1:141-149.
Skeik N, Porten BR, Isaacson E, et al. Hyperbaric oxygen treatment outcome for different indications from a single center. Ann Vasc Surg. 2015;29(2):206-214. PubMed 25308240
Zhou Y, et al. Hyperbaric oxygen for flaps and grafts: a review of controlled clinical trials. [UNVERIFIED — full citation to be confirmed before publication; survival range 62.5–100% vs 35.0–86.5% as reported in secondary reviews]
Hong Kong e-Legislation. Pharmacy and Poisons Ordinance (Cap. 138). Cap. 138 on e-Legislation
