Plastic surgery may repair many defects using a transferred tissue through different techniques concerning blood supply, types of flaps, and involved tissues, matching the patient's local needs and conditions. An increasing element of risk is related to the degree of any present hypoxia, thus creating suitable conditions for "compromised" transferred tissues.

HBO appears to posses unique physiologic effects for healing promotion, when hypoxia is present at the wound site, but seems to be of no benefit in normal healing process.

Primary goal of HBO application is to enhance tissue oxygen delivery and ATP balance, thus promoting its established effects as are: protection from reperfusion injury, edema reduction, neo-capillary formation, micro-wound environment improvement and infection resistance.

HBO may be used for preparing a granulating host base or when tissue viability is doubtful, or when previous "takes" of transferred tissues have failed.

Threatened grafts and flaps have been experimentally and clinically proved to benefit from HBO adjunct use, when it has been applied on time and in suitable cases.

As in the majority of HBO approved indications, the efficacy of HBO is still controversial in the relevant community of plastic surgeon, due to the lack of properly performed controlled, randomized clinical studies.

Despite of the above issue, recent experimental and clinical acquired experience of HBO action may confirm its specific role as adjunct treatment in the "compromised" transferred tissues, thus inviting for further application of HBO therapy in Plastic and Reconstructive surgery.

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