To explore the meta-analysis of the effect of hyperbaric oxygen therapy for burn wound healing after skin flap transplantation.

Literatures on hyperbaric oxygen therapy after flap transplantation for burn patients from the self-built database to 25 July 2019 were retrieved, including PubMed, Cochrane Library, CNKI, VIP (VIP Journal), Wanfang Medical Online, CBM database, etc., and relevant experimental data were extracted for Meta analysis. Literature screening and data collection were conducted independently by 2 researchers according to inclusion and exclusion criteria. Outcome indicators were skin survival rate, blood oxygen saturation, skin temperature, time to subside swelling, skin ruddy time, and hyperbaric oxygen treatment after skin flap transplantation. The Revman 5.3 software was used for Meta-analysis.

The risk of bias in all 12 included studies was uncertain. Among them, the clinical control study on hyperbaric oxygen treatment after flap transplantation and routine postoperative treatment included 11 literatures, which were divided into experimental group and control group according to different intervention measures. The difference in survival rate between the two groups was statistically significant [RR=1.30, 95%CI (1.23, 1.37), P < 0.0001]. The difference of blood oxygen saturation between the two groups was statistically significant [MD=19.94, 95%CI (18.16, 21.72), P < 0.0001]. Comparison of skin temperature between the two groups showed statistically significant difference [SMD=3.27, 95%CI (2.66, 3.89), P<0.0001]. The time to subside of swelling was compared between the two groups, and the difference was statistically significant [MD=-3.76, 95%CI (-4.43, -3.18), P< 0.0001]. Comparison of skin ruddy time between the two groups showed a statistically significant difference [MD=-4.56, 95%CI (-5.28, -3.84), P< 0.0001]. Study of hyperbaric oxygen treatment time after flap transplantation were included in the 5 articles, according to the postoperative hyperbaric oxygen treatment start time, divided into line immediately after hyperbaric oxygen therapy group, 10-48 h after adept hyperbaric oxygen treatment group and 48 h after hyperbaric oxygen treatment group, 3 group efficient comparison, the difference was statistically significant (P< 0.00001), immediately after hyperbaric oxygen therapy group flap survival rate was higher than 10-48 h after adept hyperbaric oxygen treatment group and 48 h after hyperbaric oxygen treatment group [RR=1.07, 1.23; 95%CI (1.01, 1.13), 95%CI (1.12, 1.25); P = 0.02, <0.0001]; There were statistically significant differences between 10~48 h after adept hyperbaric oxygen treatment group and 48 h after hyperbaric oxygen treatment group [RR=1.14, 95%CI(1.03, 1.27), P=0.01].

Compared with conventional treatment, hyperbaric oxygen therapy after flap transplantation can improve the skin survival rate, enhance the blood oxygen saturation of the wound surface, and maintain the normal skin temperature of burn patients. At the same time, it can also reduce the ruddy time of the wound, shorten the swelling time, improve the hypoxia state of the flap, enhance the growth vitality of the transplanted flap, and improve the tissue wound microenvironment. Hyperbaric oxygen therapy was used immediately after the flap transplantation, and its effect was better than that within 24 h and 48 h after the transplantation. Therefore, hyperbaric oxygen therapy can significantly improve the survival rate of skin flap, postoperative use should be as early as possible.