Is hyperbaric oxygen FDA-approved for gas gangrene?

Yes. Hyperbaric oxygen therapy is an FDA-approved adjunctive treatment for clostridial myonecrosis (gas gangrene) under Medicare NCD 20.29. It is used alongside emergency surgery and IV antibiotics.

How does HBOT treat gas gangrene?

Clostridium perfringens is an anaerobic bacterium that cannot survive in high-oxygen environments. HBOT creates conditions that are directly toxic to these bacteria, inhibits their toxin production, and supports tissue at the wound margins.

Does HBOT replace surgery for gas gangrene?

No. Emergency surgery to remove infected tissue is always the first step. HBOT begins after surgery once the patient is stable enough, and is used as part of a combined treatment approach with surgery and high-dose antibiotics.

What is the difference between gas gangrene and necrotizing fasciitis?

Gas gangrene specifically involves Clostridium bacteria infecting muscle tissue and producing gas bubbles within the tissue. Necrotizing fasciitis can be caused by multiple bacterial types and spreads along the tissue layers beneath the skin. Both are life-threatening and treated with surgery plus HBOT.

Emergency: Gas gangrene (clostridial myonecrosis) is a life-threatening emergency. Call 911 immediately. Rapid surgery is the priority — do not delay emergency care.

Hyperbaric Oxygen for Gas Gangrene (Clostridial Myonecrosis)

Gas gangrene is a rapidly progressing, life-threatening infection that destroys muscle tissue and can be fatal within hours. Hyperbaric oxygen is an FDA-approved part of treatment, used alongside emergency surgery and antibiotics.

What Gas Gangrene Is

The formal medical term is clostridial myonecrosis. Myo means muscle, necrosis means tissue death. The name tells the story.

Gas gangrene is caused primarily by Clostridium perfringens, a bacterium that produces powerful toxins as it multiplies. These toxins break down muscle and connective tissue at a rapid rate. As the bacteria metabolize, they produce gas bubbles in the tissue, which gives the condition its common name.

The bacteria enter through wounds, surgical incisions, or traumatic injuries, especially wounds that are deep or contaminated with soil. Patients develop severe, rapidly worsening pain at the wound site, followed by tissue darkening, crepitus (a crackling sensation from gas in the tissue), and systemic signs of toxicity including fever, rapid heart rate, and shock.

Without aggressive surgical treatment, it can be fatal within 24 hours.

How HBOT Treats Gas Gangrene

Clostridium perfringens is an anaerobic bacterium. It thrives in low-oxygen environments and is killed by high oxygen concentrations. HBOT works by creating exactly those conditions.

At treatment pressures of 2.4-3.0 ATA with 100% oxygen, tissue oxygen levels exceed what the bacteria can survive. At the same time, high oxygen levels inhibit bacterial toxin production, which slows the spread of tissue destruction even while the bacteria are being killed.

HBOT also supports the white blood cells at the wound margins. In hypoxic tissue, white blood cells lose much of their ability to kill bacteria. Restoring oxygen to those cells restores that killing capacity.

This means HBOT may help preserve tissue at the border of the wound. Tissue that might otherwise die and require removal could survive with restored oxygen supply.

HBOT is never a standalone treatment. It always runs alongside emergency surgery and high-dose IV antibiotics.

Treatment Protocol

Emergency surgery comes first, always. The surgeon removes infected and dead tissue and assesses how far the infection has spread.

Once the patient is stable enough for the chamber, HBOT begins. During the acute phase (first 24-48 hours), treatment typically runs 2-3 sessions per day at 2.4-3.0 ATA. As the patient stabilizes and the infection is controlled, sessions may drop to once daily.

HBOT for clostridial myonecrosis is an FDA-approved indication under Medicare NCD 20.29. The Undersea and Hyperbaric Medical Society (UHMS) includes it in their list of approved indications.

For related conditions also treated with HBOT, see necrotizing soft tissue infections and osteomyelitis. Background on how the treatment works is at what is HBOT.

Frequently Asked Questions

How is gas gangrene diagnosed?

Diagnosis is largely clinical, based on the appearance of the wound, the presence of gas in the tissue (seen on imaging or felt on exam), and the patient’s rapid deterioration. Wound cultures confirm the organism, but treatment can’t wait for culture results.

Does insurance cover HBOT for gas gangrene?

Medicare covers HBOT for clostridial myonecrosis under NCD 20.29. Most private insurers follow Medicare’s coverage standards for FDA-approved indications. Confirm coverage with your care team’s billing department.

Can gas gangrene develop after routine surgery?

It’s rare, but it has occurred after procedures where wound contamination happens. It’s more commonly associated with traumatic injuries, compound fractures, and wounds exposed to soil or fecal matter.

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.