Camison L, Naran S, Lee WW, Grunwaldt LJ, Davit AJ, Goldstein JA, O'Toole KS, Losee JE, Adetayo OA, et al.
Journal of plastic, reconstructive & aesthetic surgery : JPRAS. Date of publication 2020 Dec 1;volume 73(12):2178-2184.
1. J Plast Reconstr Aesthet Surg. 2020 Dec;73(12):2178-2184. doi:
10.1016/j.bjps.2020.05.028. Epub 2020 May 21.
Hyperbaric Oxygen Therapy for Large Composite Grafts: An Alternative in
Pediatric Facial Reconstruction.
Camison L(1), Naran S(2), Lee WW(3), Grunwaldt LJ(3), Davit AJ(3), Goldstein
JA(3), O'Toole KS(4), Losee JE(3), Adetayo OA(5).
Author information:
(1)Department of Plastic Surgery, University of Pittsburgh Medical Center and
Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania. Electronic
address: Camisonbravol@upmc.edu.
(2)Department of Plastic Surgery, University of Pittsburgh Medical Center and
Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania; Division of
Pediatric Plastic Surgery, Advocate Healthcare Hospital. Park Ridge, Illinois;
Section of Plastic and Reconstructive Surgery, University of Chicago Medicine
and Biological Sciences. Chicago, Illinois.
(3)Department of Plastic Surgery, University of Pittsburgh Medical Center and
Children's Hospital of Pittsburgh of UPMC. Pittsburgh, Pennsylvania.
(4)Department of Emergency Medicine, University of Pittsburgh Medical Center.
Pittsburgh, Pennsylvania.
(5)Division of Plastic Surgery, Section of Pediatric Plastic Surgery. Albany
Medical Center and Bernard and Millie Duker Children's Hospital at Albany
Medical Center. Albany, New York.
Comment in
J Plast Reconstr Aesthet Surg. 2021 Sep;74(9):2392-2442.
J Plast Reconstr Aesthet Surg. 2021 Sep;74(9):2392-2442.
J Plast Reconstr Aesthet Surg. 2022 Feb;75(2):891-892.
J Plast Reconstr Aesthet Surg. 2022 Feb;75(2):889-890.
BACKGROUND: Management of pediatric facial defects can be challenging, as
reattachment of large composite grafts is usually unsuccessful. Hyperbaric
oxygen therapy (HBO) has been researched to augment composite graft survival,
but clinical use for this application remains anecdotal. The authors present
their successful experience managing select cases with large composite grafts
and HBO as an adjunct.
METHODS: A retrospective chart review identified children presenting with facial
defects and managed operatively with large composite grafts (≥1.5 × 1.5 cm) and
HBO therapy. Records were reviewed for defect characteristics, management
details, and outcomes at last follow-up.
RESULTS: Nine children (avg. 8.4 years, range 1.6-15.1) presented with ear or
nose defects secondary to dog bites (n=7), falls (n=1), or congenital causes
(n=1). Three experienced ear amputations, and six suffered nasal avulsions of
varying degrees. All avulsed ears were reattached. Three cases of nose avulsions
were reattached; the other three underwent secondary reconstruction with
composite ear grafts. HBO was initiated immediately and continued for 8-10 days.
All grafts survived at least 80% with no postoperative complications. At last
follow-up (avg. 30.1 months; 0.8-63.9), all patients demonstrated good cosmetic
results with minimal residual deformity.
CONCLUSION: When reconstruction of pediatric facial defects warrants a large
chondrocutaneous graft, immediate postoperative HBO therapy can increase
survival. Particularly when reattaching amputated segments, if successful, this
approach offers an anatomically ideal result without donor site morbidity. If
unsuccessful, it does not "burn bridges" and decreases the extent of secondary
reconstruction. The authors present their HBO protocol along with a review of
available literature.
Copyright © 2020 British Association of Plastic, Reconstructive and Aesthetic
Surgeons. Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.bjps.2020.05.028
PMID: 32553822 [Indexed for MEDLINE]
Conflict of interest statement: Declaration of Competing Interest None of the
authors has a financial interest in any of the products, devices, or drugs
mentioned in this manuscript. No funding was received for this work.
