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 |
Comments:
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.
Expiry date: September 2003
References:
1. Perrins DJD. Influence of hyperbaric oxygen on the survival
of split skin grafts. Lancet 1967; 7495:868-871.
