Oxygen & Hyperbaric - Clinical uses
HBOT for selected wounds and tissue injury
Last updated 30 September 2026. How we write this .
HBOT may support healing in selected wounds and tissue injuries, but benefits depend on the diagnosis and evidence remains mixed. It is an addition to specialist care.
Start here HBOT may support healing in selected wounds and tissue injuries, but benefits depend on the diagnosis and evidence remains mixed. It is an addition to specialist care.
By the end, you will understand Why some wounds lack oxygen What HBOT changes biologically Why standard care remains central Key words used in this lesson Hyperbaric Above normal atmospheric pressure. Hyperbaric oxygen therapy involves breathing oxygen in a pressurised chamber, which increases the amount dissolved in the blood. Full plain-English glossary
Where this information comes from Claim-cited evidence. Central research claims on this lesson are linked to specific studies or official guidance.
This lesson links the specific studies and guidance used for its central claims.
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Hyperbaric oxygen therapy, or HBOT, may support compromised tissue in selected wounds and injuries by increasing the oxygen dissolved in blood. The relevant question is whether it adds meaningful benefit to standard multidisciplinary care for a clearly defined problem. Evidence varies between conditions, so a general claim that oxygen "accelerates healing" removes the diagnosis and care context that make the evidence meaningful.
Why some wounds lack oxygen
A wound needs oxygen, but oxygen shortage is rarely its only difficulty. Repair also depends on adequate blood flow, functioning immune cells, nutrients and protection from repeated damage. Infection, persistent pressure, damaged nerves and diseased blood vessels can interact, keeping a wound open even when one part of the problem improves.
Hypoxia means that tissue has insufficient oxygen for its needs. It can arise because blood delivery is reduced, swelling increases the distance oxygen must travel, or inflamed tissue consumes more oxygen. Oxygen in the bloodstream and oxygen at the wound edge are therefore different measurements: a normal finger oxygen reading does not establish that a wound has an adequate supply.
The cause matters more than the label "slow healing". A diabetes-related foot ulcer, an ulcer associated with venous disease and tissue damaged by radiotherapy have different underlying problems. Evidence about one cannot automatically answer questions about another.
What HBOT changes biologically
HBOT is a medical chamber-based intervention that combines increased surrounding pressure with oxygen exposure. Most oxygen normally travels attached to haemoglobin in red blood cells. HBOT increases the smaller amount dissolved directly in plasma, the liquid part of blood, increasing the gradient that allows oxygen to move into tissues.
This can temporarily improve oxygen availability in tissue that still has some circulation. It does not reopen a blocked artery or restore tissue that has already died. A rise in oxygen availability is therefore a plausible supporting mechanism, not proof that the underlying cause of a wound has been resolved.
Oxygen participates in collagen formation, which helps build the structural framework of repair. Some immune cells also use oxygen-dependent processes to defend against microbes. Laboratory and animal research suggests that hyperbaric exposure can influence inflammatory signalling and signals involved in new blood vessel formation. These findings explain why HBOT is studied, but they do not establish how much benefit a person will experience.
Why standard care remains central
An adjunct is an addition to established care. For a wound, that care may involve assessment of circulation, management of infection, removal of non-viable tissue, appropriate dressings and reduction of damaging pressure. Which elements matter depends on the diagnosis. HBOT cannot make these separate requirements disappear.
This creates an important research challenge. People attending a specialist hyperbaric service may also receive closer wound monitoring and more coordinated care. If their wounds improve, an uncontrolled report cannot separate the chamber's contribution from those other changes. A useful trial compares groups receiving similarly good background care, with HBOT being the main difference.
Multidisciplinary assessment also establishes what success would mean. Complete closure, sustained closure, less pain, preserved function and avoidance of major surgery are distinct outcomes. A smaller wound at an early appointment is encouraging, but it does not establish that the wound will close or remain closed.
Diabetes-related foot wounds: mixed evidence
Diabetes-related foot ulcers are among the most studied chronic wounds in HBOT research. They are not a uniform condition: loss of protective sensation, repeated loading, infection and impaired circulation contribute in different proportions. This variation helps explain why results from one group may not transfer to another.
A Cochrane review published in 2015 found a signal for better short-term healing, but that benefit was not evident at longer follow-up. Its pooled findings did not establish a clear reduction in major amputations. The trials had weaknesses in design and reporting, so the review's findings should not be presented as firm proof of durable benefit.
Small trials are especially vulnerable to imbalances in wound severity and circulation. Results also depend on whether outcomes include everyone assigned to HBOT or only those who completed it. Excluding people who became unwell or could not continue can make an intervention appear more effective than it is in everyday practice.
NICE's guideline on diabetic foot problems restricts HBOT for diabetic foot ulcers to clinical trials. This is a useful UK reference point: biological plausibility and some positive studies do not amount to a recommendation for routine use. People with diabetes should discuss wound concerns with their diabetes or foot care team, and should not change medicines based on a consumer device.
In England, NHS England routinely commissions hyperbaric oxygen therapy for decompression illness and gas embolism. Its use for wounds is not routine NHS care.
An increase in tissue oxygen is a physiological finding. It is not interchangeable with complete healing, preserved mobility or avoidance of amputation.
Late radiation injury is a different problem
Radiotherapy can cause progressive damage to small blood vessels and surrounding tissue, sometimes becoming apparent months or years later. Fibrosis, meaning scar-like tissue change, can accompany reduced blood supply. This creates a different biological setting from a fresh cut or a pressure-related ulcer, even when the visible result is tissue breakdown.
A Cochrane review published in 2023 found that HBOT may improve some outcomes in selected late radiation injuries involving the head and neck, bladder and lower bowel. Evidence for benefits was generally of low to moderate certainty. Small studies, differences between conditions and weaknesses in reporting limited confidence about who benefits and how long improvements last.
The outcome must match the problem being studied. Reduced bladder symptoms, less pain in damaged jaw tissue and fewer surgical wound complications are not the same result. Combining them into a statement that HBOT "repairs radiation damage" implies a breadth and certainty the evidence does not support.
Surgical wounds and other tissue injuries
Compromised skin grafts, flaps and traumatic injuries are sometimes discussed alongside chronic ulcers. A graft is transferred tissue that must establish a blood supply; a flap retains or receives a surgically connected supply. When either is threatened, the immediate cause of poor circulation is central. More available oxygen cannot correct a mechanical failure in that supply.
An older Cochrane review of acute surgical and traumatic wounds found insufficient high-quality evidence, although some small trials suggested benefit. That review should be recognised as historical evidence rather than a complete account of current research. It illustrates why specialist experience and promising case reports are weaker support for broad claims than reliable comparative trials.
Evidence from severely compromised tissue does not establish benefit for uncomplicated surgical recovery, ordinary cuts, exercise soreness or healthy ageing. Similarly, evidence remains too limited to make confident general claims across venous ulcers and pressure ulcers. An absence of convincing evidence is not proof of no possible effect, but it does limit what can honestly be promised.
Risks and signs that need attention
HBOT has burdens as well as possible benefits. Pressure changes can injure the ears or sinuses, and oxygen exposure can cause temporary changes in vision. Oxygen toxicity can occasionally cause serious effects, including seizures. Claustrophobia and the practical burden of attending a specialist service also matter when judging the overall balance.
New ear pain, chest discomfort or breathing difficulty during a chamber session should prompt the person to stop and alert staff immediately. Call 999 for severe breathing difficulty, new confusion or blue, grey or blotchy skin. A wound becoming increasingly painful, hot, swollen or producing pus warrants urgent contact with a GP or NHS 111; someone with diabetes should also contact their foot care team promptly. Anyone unwell after a dive should call 999, and at the coast ask for the Coastguard, saying it is a diving incident.
How to judge a healing claim
The strongest claims identify a diagnosis, a relevant comparison and an outcome that matters to patients. Before-and-after photographs cannot show what would have happened with standard care alone. They may also omit wounds that failed to improve. Useful questions include:
Were participants similar in wound cause, severity and blood supply to the people the claim targets? Was HBOT compared with equally good multidisciplinary care, ideally in a randomised trial? Were outcomes complete and sustained healing, function and harms, or only early changes in wound size? Were people who withdrew included in the analysis, and were adverse effects reported? Does the claim concern medical HBOT, or does it transfer those findings to a different consumer chamber or device? A credible account keeps mechanism, clinical evidence and uncertainty separate. Increasing dissolved oxygen may support compromised tissue in specific circumstances; it does not establish that every wound needs more oxygen. This lesson explains that distinction without diagnosing a wound or replacing individual assessment by an appropriately qualified clinician.
This lesson is general education, not medical advice or a recommendation to use or avoid hyperbaric treatment. Decisions about hyperbaric oxygen belong with a qualified clinician.
Related in this classroom The studies behind this page Hyperbaric oxygen therapy for treating chronic wounds - Cochrane Database of Systematic Reviews, 2015Hyperbaric oxygen therapy for nonischaemic diabetic ulcers: a systematic review - Wound Repair and Regeneration, 2020Sources for this classroom
Educational content only. Not medical advice, diagnosis or treatment. Always consult a qualified healthcare professional before changing your health regimen.