title: Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds.
abstract: BACKGROUND
  Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear.
  
  
  OBJECTIVE
  To determine the effects of HBOT on the healing of acute surgical and traumatic wounds.
  
  
  METHODS
  We searched the Cochrane Wounds Group Specialised Register (searched 9 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week 5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08, 2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013).
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing HBOT with other interventions such as dressings, steroids, or sham HOBT or comparisons between alternative HBOT regimens.
  
  
  METHODS
  Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author.
  
  
  RESULTS
  Four trials involving 229 participants were included. The studies were clinically heterogeneous, which precluded a meta-analysis.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery) reported no significant difference between graft survival (no data available). A third trial (36 participants with crush injuries) reported significantly more wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The fourth trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many of the predefined secondary outcomes of the review were not reported. All four trials were at unclear or high risk of bias.
  
  
  CONCLUSIONS
  There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma, these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed.
authors.affiliation: Quality Assurance & Process Innovation, Academic Medical Centre, University of Amsterdam & Amsterdam School of Health Professions, Meibergdreef 9, Amsterdam, Netherlands, 1105AZ.
authors.forename: Anne
authors.initials: A
authors.lastname: Eskes
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
mesh_terms: D000208:Acute Disease; D002056:Burns / Q000628:therapy; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D006931:Hyperbaric Oxygenation; D016032:Randomized Controlled Trials as Topic; D016038:Skin Transplantation; D014945:Wound Healing; D014947:Wounds and Injuries / Q000628:therapy*