The Efficacy of Adjuvant Hyperbaric Oxygen Therapy in Chronic Wound Management: A Narrative Review

Chronic wounds, or wounds which progress unfavourably through normal stages of healing, place a heavy burden on individuals, impeding their quality of life, and on healthcare systems, with their management annually costing the United Kingdom National Health Service over £5.6 billion. Hyperbaric oxygen therapy (HBOT) has been evidenced for use in a variety of ailments including burns and dive-related injuries. Its physiological effects, such as the stimulation of angiogenesis, bactericidal and bacteriostatic activity, and enhancement of antibiotic potency, have inspired research into its use in the management of hard-to-heal wounds. This narrative review aims to synthesize recent literature to conclude whether adjuvant HBOT improves the healing of chronic wounds when compared with traditional treatment methods. This information could be used to determine whether HBOT should be made a more mainstream treatment option for chronic wounds. A literature search and screening process resulted in 11 studies, which were reviewed, encompassing a variety of chronic wound types. The primary outcome was the rate of wound healing, in terms of complete healing and/or reduction in wound surface area. Secondary outcomes included quality of life, pain, amputation rates, improvement of underlying conditions, and bacterial burden of the wounds. There were some disparities in the literature; while some studies found HBOT to drastically improve the outcome(s), others found no statistically significant difference in healing between the HBOT and standard treatment groups. However, these disparities may be attributable to limitations in the studies or review design. Certainly, there was no evidence that HBOT worsened outcomes compared to traditional management; it was therefore recommended that it be considered earlier as an option for treatment-refractory wounds. When HBOT is unavailable or deemed inappropriate, it is recommended that other methods of oxygen delivery into the wound, such as oxygen dressings, be considered, to avail at least some of oxygen's physiological benefits.