Surgical wounds are expected to progress through a normal healing process, but in some cases recovery can be delayed by factors such as reduced blood flow, swelling, infection, diabetes, smoking history, radiation injury, or extensive tissue trauma.

When healing becomes compromised, oxygen delivery to the affected tissues may also decrease - and oxygen is one of the key ingredients required for tissue repair.  This is where Hyperbaric Oxygen Therapy (HBOT) plays a supportive role as an adjunct to surgical and wound management.

What happens during surgical wound healing?

• Inflammation.  The immune system clears damaged tissue and begins repair.

• Proliferation.  New blood vessels form, collagen is produced, and tissue begins rebuilding.

• Remodelling.  Scar tissue matures and strengthens over time.

Oxygen is essential during each stage because it supports:

• Collaged production

• Fibroblast activity

• Angiogenesis (new blood vessel growth)

• Immune cell function

• Bacterial killing mechanisms

When oxygen delivery is impaired, healing may slow significantly.

Hyperbaric Oxygen Therapy = increased dissolved oxygen in blood plasma.  The physiological effects include:

• Improved tissue oxygenation

• Support for angiogenesis

• Reduced oedema/swelling

• Enhanced leukocyte bacterial killing

• Stimulation of collagen synthesis

• Support for grafts and flaps at risk of compromise

Areas where HBOT assists in post-surgical wound healing:

Reduced swelling and oedema.  Hyperbaric oxygen reduces tissue swelling through vasoconstriction while still maintaining oxygen delivery to tissues.  HBOT helps improve oxygen availability during the repair process.

Enhanced angiogenesis.  HBOT helps stimulate new capillary formation in hypoxic tissue.  (Antioxidant response of chronic wounds to hyperbaric oxygen therapy; Sureda et al, 2026)

Support for skin grafts and flaps.  Studies have shown improved survival of compromised grafts and flaps when HBOT is used adjunctively.  (Hyperbaric oxygen therapy for acute surgical and traumatic wounds; Esks et al, 2013)

Infection support.  Oxygen plays an important role in neutrophil oxidative killing and immune defense.  Increased oxygen tension helps support the body's ability to manage certain infections alongside standard medical treatment.

What does the research say?

The research base for HBOT in post-surgical wound healing continues to evolve.  A systematic review published in the Chochrane Library found that while some smaller studies demonstrated benefits in crush injuries and skin graft survival, larger studies are still needed. (Hyperbaric oxygen therapy for acute surgical and traumatic wounds; Eskes et al, 2013)

A 2020 systematic review examining peri-operative HBOT reported promising findings regarding reduction of some postoperative complications.  (Can preventative hyperbaric oxygen therapy optimise surgical outcome?  A systemic review of randomised controlled trials; Boet et al, 2020)

A large retrospective cohort study involving 774 wound cases reported:

• 61% complete healing

• reduction in wound surface area

• improved patient quality of life

when HBOT was combined with wound care in selected patients.  (Hyperbaric Oxygen Therapy for Nonhealing Wounds - A Long-term Retrospective Cohort Study; Lalieu et al, 2023)

When might HBOT be considered?

• Delayed surgical wound healing

• Compromised grafts or flaps

• Radiation-related tissue injury 

• Diabetic surgical wounds

• Significant swelling/bruising

• Crush injury

• Problematic soft-tissue healing

• Selective post-operative infections

Final thoughts

Post-surgical healing depends heavily on adequate oxygen delivery to repairing tissue.  HBOT aims to enhance oxygen availability during this process and provides supportive benefits in selected surgical and wound-healing scenarios.

HBOT is non-invasive and has very few contraindications and relative contraindications, the main barrier to treatment is cost and time.  The research continues to evolve, the anecdotal evidence is very positive for the use of HBOT for better outcomes in post-surgical wounds.

- Samantha Winters