Hyperbaric oxygen therapy for acute surgical and traumatic wounds

Acute surgical and traumatic wounds occur as a result of a trauma or surgical procedures and whilst many heal uneventfully, sometimes poor local blood supply, infection, damage to the blood vessels, or a combination of factors result in these acute wounds taking longer to heal. Hyperbaric oxygen therapy (HBOT), which involves placing the person in an airtight chamber and administering 100% oxygen at a pressure greater than 1 atmosphere, is sometimes used with the aim of speeding wound healing. The aim is to bathe all fluids, tissues and cells of the body in a high concentration of oxygen.

This review did not find any high quality research evidence showing that HBOT is beneficial for wound healing. Two poor quality studies suggested benefits associated with HBOT. The first, in patients with crush injuries, showed improved wound healing and fewer adverse outcomes. The second reported improved survival of split skin grafts in people with burn wounds. Two trials reported no benefits associated with HBOT for either skin grafting or free flap surgery.

Further, better quality research is needed to determine the effects of HBOT on wound healing.

Authors' conclusions: 

There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma, these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed.

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Background: 

Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear. 

Objectives: 

To determine the effects of HBOT on the healing of acute surgical and traumatic wounds.

Search strategy: 

We searched the Cochrane Wounds Group Specialised Register (searched 9 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week 5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08, 2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013).

Selection criteria: 

Randomised controlled trials (RCTs) comparing HBOT with other interventions such as dressings, steroids, or sham HOBT or comparisons between alternative HBOT regimens.

Data collection and analysis: 

Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author. 

Main results: 

Four trials involving 229 participants were included. The studies were clinically heterogeneous, which precluded a meta-analysis.

One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery) reported no significant difference between graft survival (no data available). A third trial (36 participants with crush injuries) reported significantly more wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The fourth trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).

Many of the predefined secondary outcomes of the review were not reported. All four trials were at unclear or high risk of bias.

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