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Updated: Jan 8, 2026

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Refractory Osteomyelitis.

William H Tettelbach, Brett B Hart

    Undersea & Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc
    |December 22, 2025
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    Summary
    This summary is machine-generated.

    Hyperbaric oxygen (HBO₂) therapy, when combined with antibiotics and surgery, offers a safe and effective adjunctive treatment for chronic refractory osteomyelitis. This approach improves infection resolution rates, even in complex cases.

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    Area of Science:

    • Orthopedics
    • Infectious Diseases
    • Hyperbaric Medicine

    Background:

    • Chronic refractory osteomyelitis is defined by its unresponsiveness to conventional treatments.
    • Diagnosis requires failure to improve after 30 days of combined medical and surgical management.
    • Current evidence lacks conclusive randomized clinical trials for hyperbaric oxygen therapy (HBO₂) in osteomyelitis.

    Purpose of the Study:

    • To evaluate the safety and efficacy of adjunctive hyperbaric oxygen (HBO₂) therapy for chronic refractory osteomyelitis.
    • To review the scientific literature on HBO₂ therapy in conjunction with standard osteomyelitis treatments.
    • To determine optimal timing and conditions for HBO₂ administration in osteomyelitis management.

    Main Methods:

    • Comprehensive review of existing scientific literature on hyperbaric oxygen therapy for osteomyelitis.
    • Analysis of outcomes from studies, including those conducted in hospital and outpatient settings.
    • Assessment of HBO₂ therapy's role alongside surgical debridement and antibiotic treatment.

    Main Results:

    • Hyperbaric oxygen (HBO₂) therapy appears safe as an adjunct to conventional treatment for refractory osteomyelitis.
    • HBO₂ therapy improves infection resolution rates when combined with surgery and antibiotics.
    • Optimal results are achieved when HBO₂ is given with culture-directed antibiotics and soon after surgical debridement.

    Conclusions:

    • Adjunctive hyperbaric oxygen (HBO₂) therapy is a safe and effective treatment for chronic refractory osteomyelitis.
    • HBO₂ therapy can improve outcomes, especially when administered with appropriate antibiotics and surgical intervention.
    • In specific contraindications for extensive surgery, HBO₂ therapy offers a viable treatment option prior to more invasive procedures.