Is hyperbaric therapy FDA-approved for necrotizing fasciitis?

Yes. Hyperbaric oxygen therapy is an FDA-approved adjunctive treatment for necrotizing soft tissue infections under Medicare NCD 20.29. It is used alongside surgery and antibiotics, not instead of them.

Does HBOT replace surgery for necrotizing fasciitis?

No. Emergency surgery to remove dead tissue is always the first priority. HBOT is adjunctive — it begins after the initial surgery and is used to help control the infection, support wound margins, and reduce the need for repeat debridements.

How does hyperbaric oxygen fight anaerobic bacteria?

High oxygen concentrations are directly toxic to anaerobic bacteria like Clostridium species. HBOT also restores the oxygen-dependent killing ability of white blood cells in tissue that has become hypoxic from the infection.

How many HBOT sessions are needed for necrotizing fasciitis?

Protocols typically call for 2-3 sessions per day in the acute phase, then 1-2 sessions daily as the patient stabilizes. The total number of sessions depends on the severity of the infection and the patient's response to treatment.

Emergency: Necrotizing fasciitis is a life-threatening emergency. Call 911 immediately. This condition requires emergency surgery — do not delay.

Hyperbaric Therapy for Necrotizing Fasciitis and Soft Tissue Infections

Necrotizing fasciitis is one of the most aggressive bacterial infections in medicine. Even with modern surgery and antibiotics, it kills 20-40% of patients. HBOT is an FDA-approved adjunctive treatment used alongside surgery to improve those odds.

What Necrotizing Soft Tissue Infections Are

These infections spread rapidly through the soft tissue layers beneath the skin, destroying muscle, fat, and connective tissue as they go. Necrotizing fasciitis spreads along the fascial planes between skin and muscle. It moves fast enough that tissue visible in the morning may be dead by afternoon.

Several types of bacteria cause it. Group A Streptococcus is common in the media-named “flesh-eating bacteria” cases. Clostridium species cause gas-forming variants. Mixed infections involving both aerobic and anaerobic organisms are also seen.

Early warning signs:

Pain out of proportion to any visible wound or injury
Rapidly spreading redness and swelling
Fever and flu-like symptoms
Skin blistering, darkening, or breakdown

Don’t wait for test results if you suspect it. Surgeons often say the diagnosis is made in the operating room.

How HBOT Is Used in Treatment

HBOT is adjunctive. That means it follows emergency surgery, not replaces it. After the surgeon removes dead tissue, HBOT helps the wound environment fight what remains.

It works in two ways. First, the high oxygen concentration in the chamber is directly toxic to anaerobic bacteria, the organisms that drive the most destructive forms of the infection. Second, HBOT restores the killing power of white blood cells, which can’t function properly in the oxygen-depleted tissue around the wound.

HBOT may also support tissue at the wound margins. This can reduce the amount of additional tissue that needs to be removed in follow-up surgeries.

What the Research Shows

Riseman et al. (1990) published findings showing that HBOT as an adjunct to surgery reduced mortality in necrotizing fasciitis compared to surgery alone. The study found a mortality rate of 23% in the HBOT group versus 66% in the surgery-only group. Large randomized controlled trials are limited by the rarity and severity of the condition, but multiple case series support the adjunctive benefit.

HBOT for necrotizing soft tissue infections is included as an FDA-approved indication under Medicare NCD 20.29.

Role Alongside Surgery

Surgery comes first. The surgeon removes infected and dead tissue and directly inspects the wound to check for spread. That can’t be skipped or delayed.

HBOT typically starts within 24 hours of the initial surgery. Most acute-phase protocols call for 2-3 sessions per day, then 1-2 sessions daily as the patient stabilizes. The care team, which usually includes infectious disease, surgery, and hyperbaric medicine specialists, determines the schedule based on how the patient is responding.

For related conditions treated with HBOT, see gas gangrene and osteomyelitis. More background on how HBOT works is at what is HBOT.

Frequently Asked Questions

Does insurance cover HBOT for necrotizing fasciitis?

Medicare covers HBOT for necrotizing soft tissue infections under NCD 20.29 when medically necessary. Most private insurers follow Medicare’s coverage policy for FDA-approved indications. Your care team’s billing department can confirm coverage before treatment.

What’s the difference between necrotizing fasciitis and gas gangrene?

Both are severe, life-threatening soft tissue infections. Gas gangrene (clostridial myonecrosis) specifically involves Clostridium bacteria infecting muscle tissue. Necrotizing fasciitis spreads along the fascial layers and may involve multiple bacterial types. Both are treated with surgery and HBOT.

How long does recovery take?

Recovery from necrotizing fasciitis is measured in weeks to months, not days. Patients often require multiple surgeries, intensive care, and extended rehabilitation. The goal of HBOT is to support the wound and reduce the number of debridements needed.

References

Riseman, J.A. et al. (1990). Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery, 108(5), 847-850. PMID: 2244556. https://pubmed.ncbi.nlm.nih.gov/2244556/

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.