Hyperbaric Oxygen in Pre and Post-Surgical Wounds

Hyperbaric oxygen is a useful and safe complement in acute and chronic surgical wounds, both in treatment and prevention. Surgical procedures are very common in clinical practice and represent a high healthcare cost when they present complications.

Hyperbaric Oxygen Therapy (HBOT) has been used in surgical preconditioning since the early 20th century. In more recent scientific evidence such as the 2014 study by Inanmaz, 42 cases of neuromuscular scoliosis were studied in patients with cerebral palsy or myelomeningocele. The HBOT group received 30 sessions and standard postoperative antibiotic prophylaxis. These authors found that the use of HBOT significantly decreased the incidence of postoperative infections in patients with neuromuscular scoliosis, compared to the control group.

The use of hyperbaric oxygenation in surgical preconditioning was also reported in a study by Neheman published in 2020, where its effect is evidenced in children who received grafts in surgery for hypospadias. All the patients in the HBOT group had a good graft take without contraction, while 43% of the control group had graft contraction.

Different medical societies indicate the use of HBOT as a treatment. About 50% of surgical wound infections present during the first postoperative week, and nearly 90% are diagnosed within two weeks of surgery. It is especially focused on the effect on the prevention of ischemia damage, reperfusion, and its antimicrobial effect.

In 2007 Barili conducted a prospective trial with 32 patients. The results showed a significant decrease in the reinfection rate with the use of HBOT and a reduction in the duration of treatment and the days of hospitalization.

In 2016 Litwinowicz found that hyperbaric oxygenation treatment was successful in 80% of cases with deep sternal wound infection refractory to conventional treatment, using the 20-session HBOT scheme.

In the treatment of osteoradionecrosis of the jaw, HBOT is used almost exclusively as an adjunct treatment for the surgical therapy of irradiated patients undergoing maxillofacial surgeries. In a series of clinical cases presented by Hollander in 2017, it was achieved complete healing in 6 patients and on average at 10 sessions.

In 2018 Song and his team described that HBOT as an adjunctive treatment effectively reduces the rate of keloid recurrence after surgical excision and radiotherapy, by improving the oxygen level of the tissue and alleviating the inflammatory process.

Among the main effects of hyperbaric oxygenation, there is a contribution to the reduction of edema by modulation of cytokines and growth factors, correction of local or general hypoxia, stimulation of healing by participation in collagen maturation, angiogenesis, and vasculogenesis. This is why hyperbaric oxygenation therapy positively affects recovery from surgical injuries.

Sources

1. Inanmaz ME, Kose KC, Isik C, Atmaca H, Basar H. Can hyperbaric oxygen be used to prevent deep infections in neuro-muscular scoliosis surgery? BMC Surg. 2014 Oct 27;14:85
2. Neheman A, Rappaport YH, Verhovsky G, Bush N, Snodgrass W, Lang E, Zisman A, Efrati S. Hyperbaric oxygen therapy for pediatric "hypospadias cripple"-evaluating the advantages regarding graft take. J Pediatr Urol. 2020 Apr;16(2):163.e1-163.e7
3. Barili F, Polvani G, Topkara VK, Dainese L, Cheema FH, Roberto M, Naliato M, Parolari A, Alamanni F, Biglioli P. Role of hyperbaric oxygen therapy in the treatment of postoperative organ/space sternal surgical site infections. World J Surg. 2007 Aug;31(8):1702-6.
4. Litwinowicz R, Bryndza M, Chrapusta A, Kobielska E, Kapelak B, Grudzień G. Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections - a single center's experience. Kardiochir Torakochirurgia Pol. 2016 Sep;13(3):198-202.
5. Hollander MHJ, Boonstra O, Timmenga NM, Schortinghuis J. Hyperbaric Oxygen Therapy for Wound Dehiscence After Intraoral Bone Grafting in the Nonirradiated Patient: A Case Series. J Oral Maxillofac Surg. 2017 Nov;75(11):2334-2339
6. Song KX, Liu S, Zhang MZ, Liang WZ, Liu H, Dong XH, Wang YB, Wang XJ. Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate. J Zhejiang Univ Sci B. 2018 Nov.;19(11):853-862. doi: 10.1631/jzus.B1800132. PMID: 30387335; PMCID: PMC6238115