To the Editor:

I am a big fan of JWOCN and love the inclusion of international authors in our Journal, as was noted in the July/August 2014 issue! As a CWOCN of more than 20 years who enjoys having the benefits of hyperbaric oxygen (HBO) available for support in the management of challenging wounds, I was looking for that therapy's inclusion in Strategies to Promote Healing of Split Thickness Skin Grafts: An Integrative Review. Authors Achora, Muliira, and Thanka provided an excellent discussion on methodologies for wound bed preparation and graft stabilization, along some adjunctive therapies to support healing. Multiple factors were observed to influence split-thickness skin graft survival such as vascularity of the receiving graft site to enable diffusion of oxygen and nutrients from the wound bed into the grafted skin. It should be noted that a key therapeutic effect of HBO therapy includes angiogenesis via fibroblast proliferation and activation of endothelial growth factors. The increased oxygen gradient in the hypoxic tissues during hyperbaric treatment also stimulates collagen synthesis and leukocyte activity. Hyperbaric oxygen is neither necessary nor recommended for the support of normal, uncompromised skin grafts or flaps. However, in tissue where there is decreased perfusion or hypoxia, HBO has been shown to be extremely useful in graft/flap salvage and should be considered as yet another adjunctive treatment option.

Kathy Wright, RN, CWOCN-AP, ACHRN

Nanticoke Wound Care and

Hyperbaric Center

801 Middleford Rd, Seaford, DE 19940

[email protected]

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