Safety and efficacy of hyperbaric oxygen therapy in chronic wound management: current evidence

Abstract

The breathing of pure oxygen under pressure to treat tissue damage has been employed for almost 45 years and has been investigated through prospective, retrospective and randomized control trials. The physiological effects of oxygen treatment on wound tissue are profound and include the activation of immune cells, changes in cytokine production, and modulation of inflammatory and bactericidal mediators. HBO also influences the biochemistry of whole cells, altering cell proliferation, angiogenesis, clotting and tissue regeneration. The precise effects of HBO on individual cell types and tissues are only beginning to be revealed in both animal and human studies. Many independent studies using HBO adjunctively with standard wound care have observed improved healing, most particularly for diabetic foot ulcers, and can result in a significant reduction in major amputations. Side effects occur infrequently, but myopia, ear barotrauma and rarely oxygen toxicity have been reported. As antibiotics become less available, and clinician time and complex dressings become more expensive, the use of HBO as a means of treating a variety of wound types may become an increasingly appropriate option for treatment.