Adjunctive Hyperbaric Oxygen Therapy for a Refractory Sickle Cell-Associated Leg Ulcer: A Case Report

Sickle cell leg ulcers (SCLUs) are a chronic and debilitating complication of sickle cell disease (SCD), often associated with severe pain, impaired mobility, delayed healing, and recurrence. Their management remains challenging because ulcer formation and persistence are driven by multiple overlapping mechanisms, including hemolysis-associated vasculopathy, microvascular dysfunction, chronic inflammation, venous disease, and local tissue hypoxia. Despite standard measures such as local wound care, compression therapy, infection control, analgesia, and optimization of SCD-directed treatment, many ulcers remain refractory, and high-quality evidence guiding treatment is limited. We report a 44-year-old man with homozygous SCD (HbSS) and chronic venous disease who developed a painful refractory medial malleolar ulcer that failed to improve with conventional management. Adjunctive hyperbaric oxygen therapy (HBOT) was administered alongside standard wound care and was well tolerated, with no treatment-related adverse events. Two months after completion of therapy, the ulcer showed near-complete healing, accompanied by complete pain resolution and restoration of normal ambulation. This case provides additional clinical evidence that HBOT may be feasible and potentially useful in selected patients with refractory SCLUs; however, causality cannot be established from a single case, and prospective evaluation is required.