Soft Tissue Injury and Wound Healing

Carter, Marissa J. PhD, MA*; Eckert, Kristen A. MPhil*; Fife, Caroline E. MD†,‡; Gelly, Helen B. MD§. Systematic Review of Comparative Studies Evaluating Hyperbaric Oxygen Therapy on Skin Flap and Graft Surgical Indications. Plastic & Reconstructive Surgery-Global Open 14(5):p e7750, May 2026. | DOI: 10.1097/GOX.0000000000007750

More evidence of HBOT utility for soft tissue injury and wound healing

Systematic Review of Comparative Studies Evaluating Hyperbaric Oxygen Therapy on Skin Flap and Graft Surgical Indications

Carter, Marissa J. PhD, MA*; Eckert, Kristen A. MPhil*; Fife, Caroline E. MD†,‡; Gelly, Helen B. MD§

 

Plastic & Reconstructive Surgery-Global Open 14(5):p e7750, May 2026. | DOI: 10.1097/GOX.0000000000007750

Background: 

This systematic review aims to determine whether pre- and postoperative hyperbaric oxygen therapy (HBOT) incurs any benefits or harms in soft tissue injuries (STIs) considered for skin flap or graft surgery.

Methods: 

We included adequately powered clinical trials that enrolled patients with STIs serious enough for skin flaps or grafts; evaluated HBOT (≥1.5 ATA) versus control, placebo, or sham procedures; and analyzed survival/healing and complication rates. MEDLINE, Google Scholar, and Embase were searched for relevant literature through June 30, 2024. The Cochrane risk of bias (RoB 2) and the ROBINS-I tools assessed RoB. Meta-analysis and random effects models analyzed randomized controlled trial (RCTs) evaluating flap/graft survival rates within 4 weeks of HBOT (2-2.5 ATA). The GRADE approach determined the evidence recommendations.

Results: 

Among 743 records screened, 45 were assessed; 25 reports from 24 studies (13 RCTs; 11 non-RCTs; 2246 patients) were included. RCT RoB ranged from low RoB (1 trial) to high (2 trials). Nonrandomized trials had moderate RoB (n = 5, 45%), whereas 6 had serious RoB. Four RCTs showed a large, horizontal overall effect size (log odds ratio, 1.045; standard error, 0.3104; z, 3.3.67; P < 0.001; 95% confidence interval, 0.44–1.65). Evidence levels were very low to moderate, with 11 strong and 13 conditional recommendations, including a strong recommendation to use HBOT to heal flaps/grafts in STI/trauma wounds.

Conclusions: 

A strong recommendation for pre- and postoperative HBOT is warranted to mitigate the need for flap/graft surgery and heal flaps and grafts, given the potentially life- and/or limb-threatening harms that could otherwise occur.