title: Hyperbaric oxygen therapy: solution for difficult to heal acute wounds? Systematic review.
abstract: BACKGROUND
  Hyperbaric oxygen therapy (HBOT) is used to treat various wound types. However, the possible beneficial and harmful effects of HBOT for acute wounds are unclear.
  
  
  METHODS
  We undertook a systematic review to evaluate the effectiveness of HBOT compared to other interventions on wound healing and adverse effects in patients with acute wounds. To detect all available randomized controlled trials (RCTs) we searched five relevant databases up to March 2010. Trial selection, quality assessment, data extraction, and data synthesis were conducted by two of the authors independently.
  
  
  RESULTS
  We included five trials, totaling 360 patients. These trials, with some methodologic flaws, included different kinds of wound and focused on different outcome parameters, which prohibited meta-analysis. A French trial (n = 36 patients) reported that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11-2.61]. Moreover, there were significantly fewer additional surgical procedures required with HBOT (RR 1.60, 95% CI 1.03-2.50), and there was significantly less tissue necrosis (RR 1.70, 95% CI 1.11-2.61). In one of two American trials (n = 141) burn wounds healed significantly quicker with HBOT (P < 0.005) than with routine burn care. A British trial (n = 48) compared HBOT with usual care. HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35-9.11). In a Chinese trial (n = 145) HBOT did not significantly improve flap survival in patients with limb skin defects.
  
  
  CONCLUSIONS
  HBOT, if readily available, appears effective for the management of acute, difficult to heal wounds.
authors.affiliation: Department of Quality Assurance & Process Innovation, Room A3-503, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Eskes
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Lubbers
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
mesh_terms: D000208:Acute Disease; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*