Hyperbaric oxygen in cutaneous burn injury: a missing rung on the reconstructive ladder?

Dr Edward Siddens1, Dr Helen Douglas1, Professor  Suzanne Rea1, Professor  Fiona  Wood1

1State Burns Service WA


Hyperbaric oxygen therapy involves the administration of 100% oxygen at pressures greater than 1 atm.  First used in 1834, it is most commonly employed for the treatment of decompression sickness and carbon monoxide toxicity; though more recently has been trialled in the treatment of necrotizing fasciitis, chronic wounds and cutaneous burn injuries. A review of the available evidence for the use of hyperbaric oxygen therapy in the treatment of burn injuries was performed.


A literature search of the Cochrane, PubMed, Medline, and Google Scholar databases was performed, which revealed 14 relevant articles.


Of the 14 articles reviewed, there were:

1 Cochrane review

3 randomized controlled trials in humans,

4 observational studies

2 cohort studies

1 case report

3 randomized control trials in animals

Though uncontrolled studies and animal data show promising results with HBOT in burn injury, this has not been translated to large clinical trials and issues with methodological design have been noted in several cases.


Robust data for the use of HBOT in burn injury is lacking, although the limited success seen in chronic wounds and diabetic foot ulcers is encouraging. The natural next step is to design a large RCT to assess the efficacy of HBOT in burn injuries and a proposed RCT design for the state burns unit in WA is described.

Ed Siddens is a registrar in plastic surgery and burns working in WA

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