Hyperbaric Oxygen Therapy for Compromised Skin Grafts and Flaps

The key word is compromised. HBOT is considered for a graft or flap that is showing signs of trouble, or for a surgical site at high risk, not for every graft. Your surgeon usually recognizes the problem first. Signs can include:

• skin that looks pale, dusky, bluish or mottled,
• swelling or congestion, often with a purple color,
• slow color return after gentle pressure (delayed capillary refill),
• blistering, or loss of part of the graft or flap.

Patients are commonly referred by plastic and reconstructive surgeons, ear, nose and throat surgeons, oral surgeons, orthopedic surgeons and trauma teams. Situations include flaps after breast reconstruction, reconstruction after skin cancer removal, grafts after injuries or burns once the acute phase has passed, and surgery in previously irradiated tissue. For that last group, see flaps in irradiated tissue.

Routine recovery after cosmetic or other surgery is not a cleared indication. HBOT is not a way to speed up normal healing after a procedure.

Your physician determines whether HBOT is appropriate, in discussion with your surgeon. If a wound near a graft simply isn't closing, see non-healing surgical wounds.

Timing: why early matters

A failing graft or flap can change over hours to days. Published reviews of HBOT for compromised grafts and flaps emphasize starting as soon as compromise is recognized, because tissue that has already died cannot be rescued. If you are a patient, contact your surgeon first. If your surgeon suggests HBOT, or you are a surgeon's office, call (369) 222-0979 and tell us it is time-sensitive. Sessions are by appointment, and we will be straightforward about how quickly we can see you.

Dermal filler vascular occlusion

Rarely, a cosmetic filler injection can block a blood vessel and cut off blood supply to the skin. Warning signs include sudden pain, blanching or a blotchy, dusky pattern near the injection site, and any change in vision. This is an emergency. The first step is to contact the injector right away, since hyaluronic acid fillers are commonly dissolved with an enzyme called hyaluronidase. Any vision change needs an emergency room immediately. Case reports describe HBOT as an adjunct in some filler complications, but it is not the first-line response and is not a substitute for emergency care.

At Generations Wellness, care is directed by Dr. Rajwinder Singh Bahia, MD. Sessions take place in hard-shell monoplace chambers, each for one person, where you breathe medical-grade oxygen at a physician-prescribed pressure while staff stay in communication with you.

• Pressure: commonly 2.0 to 2.4 ATA, as prescribed by your physician.
• Session length: about 90 to 120 minutes including pressurization and depressurization.
• Course length: graft and flap courses are often shorter and more intensive than wound-care courses. Your physician sets the schedule with your surgeon, based on how the tissue looks and responds.
• Monitoring: the surgical site is checked and photographed so changes can be tracked and shared with your surgeon.
• Your surgeon stays in charge of dressings, drains, medications and any further surgery.

For a walk-through of a visit, read what a session involves.

Generations Wellness currently offers HBOT on a self-pay basis. We do not bill insurance, Medicare or Medi-Cal today while we work toward insurance contracts.

In general, this is one of the indications insurance may cover. Original Medicare's NCD 20.29 covers HBOT for the preparation and preservation of compromised skin grafts, though not for the primary management of wounds. At facilities that bill Medicare, patients typically pay the Part B deductible ($283 in 2026) and then 20% coinsurance. Commercial and Medicare Advantage plans commonly require prior authorization, which can take time, so ask your surgeon's office early.

Published national self-pay ranges for medical-grade HBOT at independent centers run about $150 to $450 per session. These are ranges, not quotes. We review pricing clearly at your consultation. Because timing matters here, if you have coverage that may apply, ask us and we'll explain your options honestly, including when a covered setting may be the better choice. See Medicare coverage for compromised grafts and HBOT cost.