Association of Hyperbaric Oxygen Therapy with Healing Trajectories in Chronic Non-Healing Wounds: A Prospective Observational Analysis

Background: Chronic non-healing wounds represent as a substantial clinical challenge and are frequently associated with tissue hypoxia, persistent inflammation, infection, and increased risk of limb loss. Hyperbaric oxygen therapy (HBOT), by increasing tissue oxygen availability under hyperbaric conditions, has been used as an adjunctive modality in the management of refractory wounds; however, the clinical association between this therapy and wound-healing outcomes remains variable.

Objective: To evaluate the association between hyperbaric oxygen therapy and healing outcomes in patients with chronic non-healing wounds.

Methods: A prospective observational study was conducted over a one-year period at a tertiary care center. Sixty adult patients (29 patients (<26sessions), 31 (27-37 sessions)) with chronic non-healing wounds (Wagner grade 2–4) were enrolled and received hyperbaric oxygen therapy at 2.0–2.5 atmospheres absolute for 60–90 minutes per session, five days per week, for four weeks. Wound surface area, granulation tissue formation, wound discharge, local inflammation, and final wound outcomes were assessed at baseline and at weekly intervals. Patients were stratified based on the number of HBOT sessions completed. Data were analyzed using IBM SPSS version 25, and statistical significance was set at p ≤ 0.05.

Results: A progressive reduction in wound surface area was observed over the treatment period, with patients completing a higher number of HBOT sessions demonstrating a significantly greater reduction by day 21 (p < 0.001). Significant reductions in wound discharge (p = 0.002) and local inflammation (p = 0.002) were also observed. Improvement in granulation tissue formation was noted in both groups, although intergroup differences were not statistically significant. Complete wound healing was observed in a higher proportion of patients who completed 27–37 HBOT sessions (93.5%) compared to those who completed fewer sessions (65.5%), with a significant association between session number and wound outcome (p = 0.002).

Conclusion: In this prospective observational cohort, hyperbaric oxygen therapy was associated with favorable wound healing outcomes, including reduced wound size, decreased discharge and inflammation, and improved overall healing, particularly with higher treatment exposure. These findings supported the role of HBOT as a potential adjunct to standard wound care in selected patients with chronic non-healing wounds, while underscoring the need for controlled studies to establish causality