Hyperbaric oxygen therapy for acute surgical and traumatic wounds

Eskes A, Ubbink DT, Lubbers M, Lucas C, Vermeulen H

Published Online:

February 16, 2011

Acute surgical and traumatic wounds occur as a result of a trauma or surgical procedures and whilst many heal uneventfully, sometimes poor local blood supply, infection, damage to the blood vessels, or a combination of factors results in acute wounds taking longer to heal. Hyperbaric oxygen therapy (HBOT), which involves placing the patient in an airtight chamber and administering 100% oxygen for respiration, at a pressure greater than 1 atmosphere, is sometimes used with the aim of speeding wound healing. The aim is to bathe all fluids, tissues and cells of the body in a high concentration of oxygen.

This review did not find any high quality research evidence showing that HBOT is beneficial for wound healing. Two poor quality studies suggested benefits associated with HBOT. The first in patients with crush injuries, showed improved wound healing and fewer adverse outcomes. The second reported improved survival of split skin grafts. A third trial reported no benefits associated with HBOT for skin grafts.

Further, better quality research is needed to determine the effects of HBOT on wound healing.

Abstract (click to read)

Background:

Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma) however the effects of HBOT on wound healing are unclear.

Objectives:

To determine the effects of HBOT on the healing of acute surgical and traumatic wounds.

Search strategy:

We searched the Cochrane Wounds Group Specialised Register (25 August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3), Ovid MEDLINE (1950 to August Week 2 2010 ), Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 24, 2010), Ovid EMBASE (1980 to 2010, Week 33) and EBSCO CINAHL (1982 to 20 August 2010).

Selection criteria:

Randomised controlled trials (RCTs) comparing HBOT with other interventions or comparisons between alternative HBOT regimens.

Data collection and analysis:

Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author.

Main results:

Three trials involving 219 participants were included. The studies were clinically heterogeneous, therefore a meta-analysis was inappropriate.

One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (36 participants with crush injuries) reported significantly more wounds healed with HBOT than with sham HBOT (RR 1.70; 95% CI 1.11 to 2.61) and fewer additional surgical procedures required with HBOT: RR 0.25; 95% CI 0.06 to 1.02 and significantly less tissue necrosis: RR 0.13; 95% CI 0.02 to 0.90). A third trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).

Many of the predefined secondary outcomes of the review, including mortality, pain scores, quality of life, patient satisfaction, activities daily living, increase in transcutaneous oxygen pressure (TcpO2), amputation, length of hospital stay and costs, were not reported. All three trials were at unclear or high risk of bias.

Authors' conclusions:

There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed.

This record should be cited as:

Eskes A, Ubbink DT, Lubbers M, Lucas C, Vermeulen H. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD008059. DOI: 10.1002/14651858.CD008059.pub2

Assessed as up to date:

August 25, 2010

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Primary Review Group:

Wounds Group

Health topics:

Orthopaedics & trauma > Wounds > Laceration/traumatic wounds

Skin > Wounds > Laceration/traumatic wounds

Wounds > Surgical wounds > Systemic wound care

Wounds > Laceration & trauma

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Hyperbaric oxygen therapy for acute surgical and traumatic wounds

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