Dr. Schlesinger Discusses Hyperbaric Oxygen Therapy and Surgical Recovery

By Breast Implant Center of Hawaii

Dr. Schlesinger Discusses Hyperbaric Oxygen Therapy and Surgical Recovery

Healing from plastic surgery requires plentiful blood supply—and when it is compromised, surgical outcomes and the patient’s well-being can be at risk. To tip the odds in your favor, Hyperbaric Oxygen Therapy (HBOT) is an excellent treatment option that has been proven to increase blood supply, treat and prevent infection, and improve surgical outcomes. Here, I explain HBOT and its positive impacts on surgical recovery.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy (HBOT) is a treatment method that utilizes a special chamber with air pressure 1.5-3 times higher than normal; pure oxygen that is pumped inside for a patient to breathe. This technology has been in use since the early 20th century and has proven effective at treating a number of serious medical conditions.

How Hyperbaric Oxygen Therapy works

Oxygen is essential for tissue survival—but the air you breathe is only about 21% oxygen. But the air that is pumped into a hyperbaric chamber is 100% oxygen, and the increased air pressure inside the chamber allows the lungs to collect more oxygen. This combination of pure oxygen and the amplified ability to take in more of it helps your body to more efficiently heal itself. Other benefits include:

Additionally, HBOT increases the rate of neovascularization in two ways: angiogenesis and vasculogenesis. When dominant blood vessels are choked, HBOT enhances angiogenesis—the process in which new blood vessels bud off from existing blood vessels. In response to compromised tissue, angiogenesis triggers the release of vascular endothelial growth factors (VEGF). The VEGF races to the wound and forms tubules off of post-capillary venules to connect oxygen-starved tissue to existing blood supplies. HBOT also supports vasculogenesis, the formation of new blood vessels.

These processes are instrumental in boosting tissue survival rates, and I encourage my fellow plastic surgeons to make HBOT part of their patient’s treatment plans when complications arise.

This technology has been in use since the early 20th century and has proven effective at treating a number of serious medical conditions.

Hyperbaric Oxygen Therapy (HBOT) in plastic surgery

There are numerous indications for the use of HBOT in plastic surgery recovery, but supporting a compromised skin graft or skin flap is the most frequent indication for the use of HBOT as both skin grafts and skin flaps are commonly used to perform plastic surgery procedures. (A skin graft is a piece of skin that is transferred from one area of the body to another without a blood supply and its survival depends on the quality of the wound bed for revascularization. A skin flap is tissue with an inherent blood supply, meaning its blood supply is intact.)

Additional uses for HBOT in plastic surgery recovery include cases of:

These various healing issues are typically accompanied by symptoms such as fever, redness or heat from the area (which typically indicates infection), or unnaturally cold tissue (which typically indicates low or no blood supply). Symptoms typically present anywhere from 12 hours up to 3 or 4 days after surgery.

While MRI imaging can be used to detect compromised tissues, it is usually unnecessary as it’s often quite obvious when tissue is in trouble. A simple technique called blanching can help determine if an area has sufficient blood flow: apply firm pressure to the skin for a few seconds and then quickly release. The area will appear almost white initially and then return to its normal color within 4 seconds. If the area does not return to its normal color within that time frame, it may indicate insufficient blood flow is moving through the area. If you perform this test at home and do not see your normal coloring within 4 seconds, immediately consult with your physician for the next steps.

HBOT as an alternative to surgical intervention

When a plastic surgeon identifies an infection or tissue necrosis postoperatively, they may default to cutting it out—but this is an outdated approach to treating these conditions and requires the patient to undergo another procedure. It is also costly for the patient, as it means they will be put under anesthesia again and be vulnerable to the risks associated with it. Thankfully, research has shown that HBOT is highly-effective at treating compromised tissue and can be combined with antibiotics if needed to avoid subjecting the patients to additional surgeries and the potential for a poor aesthetic outcome.

In my blog, Laser-Assisted Lipo May Lead to Future Tummy Tuck Complications, I explained how this liposuction technique fries vital blood vessels in the superficial fascial system (SFS) and may cause the patient to lose tissue flexibility and reduce the blood supply in that area. I saw the effect of fried blood vessels in my practice and immediately referred my tummy tuck patient to HBOT—after which she healed beautifully with no further surgical intervention. In similar cases that were not supported by HBOT, patient outcomes were compromised.

Protocols for HBOT

To have the maximum effect, HBOT should be started as soon as symptoms of poor wound healing appear. Currently, there is no consensus on the optimal treatment regimen; a general guideline ranges from 90-120 minutes at 1.5-3 times the normal air pressure. The number of treatments, duration of each treatment, and the air pressure settings depend on the surgeon’s knowledge of HBOT and the patient’s condition.

I strongly encourage fellow plastic surgeons to familiarize themselves with using HBOT as the first line of defense when their patients experience postoperative complications. Patients considering plastic surgery should discuss their prospective surgeon’s protocols in addressing poor wound healing and advocate for HBOT should they experience complications.

About Dr. S. Larry Schlesinger in Honolulu: Dr. Schlesinger is a board-certified plastic surgeon with over 30 years of plastic surgery experience. He has published numerous articles over his career to advance the science and artistry of aesthetic medicine. Dr. Schlesinger is highly respected for his surgical expertise by patients and those in the plastic surgery community. Dr. Schlesinger and the outstanding medical team at the Breast Implant Center of Hawaii invite you to call our office at (808) 597-8835 or contact us online to schedule a consultation so we can help you safely achieve your appearance goals!

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