Current Use of Hyperbaric Oxygen Therapy in Plastic Surgery: A Systematic Review.

BACKGROUND

Hyperbaric oxygen therapy (HBOT) involves delivering 100% oxygen at pressures greater than 1 atmosphere and is used in several specialties. In plastic surgery, HBOT has been applied to ischemic wounds, compromised flaps, and tissue injury. Despite its growing use, comprehensive evaluations of its indications, complications, and outcomes remain limited.

METHODS

A systematic review was performed in February 2025 using PubMed, Embase, and Cochrane. The Preferred Reporting for Items for Systematic Reviews and Meta-Analyses guidelines were followed. Abstracts and full texts were reviewed independently by 2 reviewers, with a third reviewer resolving disagreements. Included studies evaluated HBOT in plastic surgery indications, including wounds, grafts, flaps, infections, and extremity limb salvage.

RESULTS

The search yielded 355 studies, of which 30 underwent full-text review and 18 met inclusion criteria. These studies included 1281 patients, with 786 treated with HBOT and 495 without. Study designs included cohort studies (16.6%), case-control studies (5.6%), randomized controlled trials (11.1%), and case series (66.6%). Meta-analysis demonstrated a 52% reduction in complication rates with HBOT (odds ratio 0.48; 95% confidence interval: 0.09, 2.66; P = 0.40; I 2 = 82.4%), however, high heterogeneity limited interpretability. HBOT improved infection control (up to 82.6%), wound healing (43.9%-100%), limb salvage (81%-94.4%), and flap and graft survival (64%-100%).

CONCLUSIONS

HBOT shows benefit as an adjunct in plastic surgery, particularly for chronic wounds, limb preservation, and flap or graft salvage. Further standardized studies are needed to define optimal treatment protocols and patient selection.