Adjunctive Hyperbaric Oxygen Therapy for Severe Traumatic Limb Injuries: A Systematic Review and Meta-Analysis

Background and Objectives: Severe traumatic limb injuries, particularly those involving extensive soft tissue damage, present significant challenges in clinical management. Thus, we aimed to critically assess the effectiveness of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for severe traumatic limb injuries. Materials and Methods: For this systematic review and meta-analysis, we conducted a systematic search of MEDLINE/PubMed, Embase, and the Cochrane Library for studies published up to 7 March 2026. We included studies evaluating the effectiveness of adjunctive HBOT in patients with severe limb injuries. The prespecified primary outcome was complete wound healing, while secondary outcomes included time to wound healing, wound necrosis, length of hospital stay (LOS), and wound infection. Risk of bias was assessed using the ROBINS-I tool for observational studies and the Cochrane RoB 2.0 for randomized controlled trials (RCTs). Results: Seven studies (three RCTs and four observational) were included. A high risk of bias was identified in two RCTs, and a serious risk of bias was noted across all four observational studies. Complete wound healing was reported in one randomized trial and favored HBOT, but the certainty of evidence was very low. The time to wound healing did not differ between the HBOT and control groups (MD, -1.44; 95% CI, -6.70 to 3.82, I² = 0%). The LOS did not differ between the HBOT and control groups (MD, -3.39; 95% CI, -14.74 to 7.79, I² = 94%). However, wound infection rates were lower in the HBOT group compared to the control group (OR, 0.31; 95% CI, 0.22-0.45, I² = 20%). Similarly, wound necrosis rates were reduced in the HBOT group (OR, 0.23; 95% CI, 0.12-0.45, I² = 41%). Conclusions: Evidence is insufficient to determine whether HBOT improves complete wound healing. Although HBOT may reduce wound infection and necrosis, the certainty of evidence was low to very low.