Summary of HBOT in Post-Surgical Recovery
- FDA and UHMS Approved: Recognized for treating grafts, burns, infections, radiation injuries, and tissue necrosis.
- Proven Track Record: Established since the 1950s for healing complex wounds and reducing complications.
- Broad Applicability: Enhances post-surgical recovery through improved oxygenation, reduced swelling and inflammation, and increased collagen production, benefiting even those without complications.
Case Strategy
- Standard Care: 5–10 sessions to reduce swelling and bruising and support early healing, to be customized to surgery type and patient needs.
- Comprehensive Recovery: 10–20 sessions for enhanced tissue regeneration, angiogenesis, and collagen production.
- Complicated Post-Surgical Cases: Extended sessions tailored to individual recovery goals and medical conditions.
Postsurgical recovery and wound healing represent a complex and multifaceted process, involving a delicate balance of various physiological factors and the patient’s overall health and comorbidities. There is a rising trend among surgeons to incorporate hyperbaric oxygen therapy as part of post-surgical care, with the goal of enhancing patient outcomes regardless of the presence or absence of complications.
Hyperbaric Oxygen Therapy (HBOT) serves as a valuable adjunctive treatment in post-surgical and post-injury recovery due to its ability to enhance tissue oxygenation, promote angiogenesis, reduce oedema, modulate inflammation, and overall accelerate wound healing.
This article explores the underlying mechanisms and scientific rationale that support the efficacy of HBOT in enhancing recovery and patient outcomes:
- Enhanced Tissue Oxygenation: Adequate oxygenation is crucial for effective wound healing, as insufficient oxygen levels can hinder the process and increase the risk of infection. Hyperbaric oxygen therapy (HBOT) supports wound healing by delivering oxygen-enriched plasma to tissues that is deprived of sufficient oxygen. HBOT, depending on the applied pressure, can dramatically elevate the body’s oxygen concentration, potentially up to 1,200%. This significant increase in tissue oxygen concentration, combined with the elevated pressure, triggers various beneficial physiological responses, such as improved blood perfusion, stem cell mobilization, and a reduction in inflammation. Together, these effects promote the regeneration of damaged tissues and accelerate the healing process.
- Angiogenesis (The formation of new blood vessels ): Hyperbaric oxygen therapy (HBOT) promotes the growth of new blood vessels in damaged tissues, primarily by enhancing the production of vascular endothelial growth factor (VEGF). Studies on tissue oxygenation have shown that angiogenesis becomes measurable after eight HBOT sessions, and by 20 sessions, vascularity in treated tissues reaches 80-85% of normal levels observed in non-irradiated tissue. Importantly, the effects of HBOT on tissue oxygen pressure appear to be long-lasting, with studies reporting that tissue oxygen levels remain at 90% of their post-treatment values even three years after completing therapy.
- Stem Cell Proliferation: Hyperbaric oxygen therapy (HBOT) aids in tissue repair and regeneration by stimulating the proliferation of stem cells. These stem cells have the unique ability to differentiate into various cell types, including skin cells, to replace damaged tissue. Research has demonstrated that a single exposure to hyperbaric oxygen at 2.0 atmospheres absolute for two hours can double the population of CD34 cells, a key marker of stem cell activity, in the peripheral blood. Furthermore, after 20 sessions of HBOT, there is an observed eight-fold increase in these stem cell markers, highlighting the therapy’s potent role in enhancing stem cell activity for tissue regeneration.
- Reduced Edema: Surgery often leads to oedema, or swelling, as a natural part of the body’s healing process. However, this swelling can exacerbate hypoxia by compressing nearby blood vessels. Hyperbaric oxygen therapy (HBOT) helps reduce oedema through several mechanisms, including vasoconstriction, enhanced oxygenation, and decreased inflammation. These combined effects contribute to reduced swelling and improved tissue function, promoting faster recovery and better overall healing.
- Anti-inflammatory Effects: Inflammation is a natural response to surgery and injury, but excessive inflammation can lead to complications and slow down the healing process. The intensity of the inflammatory response varies based on the type of surgery or injury, with higher levels of inflammation potentially leading to serious complications and slowing down the healing process. Hyperbaric oxygen therapy (HBOT) exerts anti-inflammatory effects through multiple mechanisms. It reduces the production of pro-inflammatory cytokines, inhibits leukocyte adhesion to blood vessel linings, decreases oedema, uses oxygen as a signalling molecule to modulate the inflammatory response, and boosts the production of anti-inflammatory mediators. These actions collectively help control excessive inflammation, promoting a more efficient healing process.
- Pain Management: By enhancing tissue oxygenation and reducing swelling and inflammation, hyperbaric oxygen therapy (HBOT) can help alleviate post-operative neuropathic pain and support functional recovery.
- Fibroblast Activation and Increased Collagen Production: Fibroblasts are essential skin cells involved in wound healing and maintaining skin firmness. The oxygen-rich environment provided by hyperbaric oxygen therapy (HBOT) stimulates fibroblast proliferation and boosts collagen production, thereby supporting the repair and reconstruction of damaged tissue.
Summary:
The Clinical Evidence: Hyperbaric oxygen therapy (HBOT) has been approved by the FDA and the Undersea and Hyperbaric Medical Society (UHMS) for various conditions, including compromised grafts and flaps, acute thermal burn injuries, gas gangrene, necrotizing soft tissue infections, delayed radiation injuries, and soft tissue and bony necrosis. Its use dates back to the 1950s, with extensive academic research confirming its effectiveness in promoting the healing of chronic wounds, enhancing post-operative recovery, reducing complications, and improving overall patient outcomes.While the use of HBOT for post-surgical recovery in healthy patients with expected normal healing has limited empirical evidence, it is theoretically plausible that this therapy could accelerate recovery for such individuals too. This is due to HBOT’s mechanisms—enhanced tissue oxygenation, reduced inflammation, and increased collagen production—which align with the physiological requirements for optimal tissue healing and regeneration.
The Clinical Experience: At our facility, we have observed an increasing number of patients referred by their operating surgeons for hyperbaric oxygen therapy (HBOT). Referring surgeons often base their recommendations not only on existing medical evidence but also on their clinical observations of HBOT’s effectiveness in accelerating the healing process.
The medical team at NUMA has extensive experience delivering HBOT to support patients during post-operative recovery. Additionally, they work closely with referring surgeons to ensure that care is both safe and effective, fostering a collaborative approach to optimizing patient outcomes.
Safety: Although hyperbaric oxygen therapy (HBOT) is generally considered very safe, it may not be suitable for all patients and can occasionally result in rare side effects. For this reason, it is essential that patients are evaluated by a physician with expertise in HBOT before starting treatment. The therapy should only be administered in a medical facility under the supervision of a qualified medical doctor.
At NUMA, every patient undergoes a comprehensive pre-treatment evaluation to assess their suitability for HBOT and to identify any potential contraindication and to ensure the safety and effectiveness of the therapy for each individual.
Treatment Protocol:
a. Pre-surgical Treatment: An increasing number of surgeons are advising patients to undergo one or two sessions of hyperbaric oxygen therapy (HBOT) before surgery to help reduce the risk of post-surgical complications. While the physiological rationale for preoperative HBOT is strong, empirical research on its use as a pre-surgical intervention is still limited.
For instance, a retrospective cohort study on abdominoplasty patients showed that preoperative HBOT reduced postoperative complication rates from 32.6% to 8.4% and completely eliminated necrosis in the HBOT group. Similarly, in pancreaticoduodenectomy, a single preoperative HBOT session significantly reduced complication rates, highlighting its potential benefits in complex surgeries.
However, if resources are limited, prioritizing postoperative HBOT treatment is recommended. Although early evidence points to potential benefits, outcomes can vary significantly depending on the type of surgery and patient characteristics. Further research is needed to develop standardized protocols and identify which patients are most likely to benefit from HBOT as a preconditioning intervention.
b. Post-Surgical Treatment: Provided there are no complications, post-surgical hyperbaric oxygen therapy (HBOT) protocols typically involve 5–10 sessions aimed at supporting the early stages of healing by minimizing swelling, reducing bruising, and accelerating wound repair. These are tailored to the severity of the surgery or injury, the patient’s underlying comorbidities, and their individual response to treatment.
For patients aiming for more comprehensive recovery benefits, including enhanced tissue regeneration, angiogenesis, and sustained increases in collagen density, a personalized treatment plan of 10–20 sessions is recommended. In cases where post-surgical complications arise, a longer course of HBOT may be required. This individualized approach is carefully designed to align with each patient’s unique recovery goals and medical needs, ensuring the best possible outcomes.