Hyperbaric Oxygen Therapy for Non-Healing Wounds
HBOT is FDA-approved for chronic non-healing wounds. Learn which wound types qualify, how the treatment works, what to expect, and how to access coverage.
Hyperbaric Oxygen Therapy for Wounds
The FDA has cleared hyperbaric oxygen therapy (HBOT) for chronic, non-healing wounds. It’s one of the most common reasons people receive HBOT today.
If you have a wound that isn’t getting better, this page will help you understand whether HBOT might be an option for you. Learn more about what HBOT is and how it works.
What Makes a Wound “Non-Healing”?
A wound is considered non-healing when it hasn’t shown measurable healing progress after 30 days of standard wound care. Doctors also call these chronic wounds.
Several types of wounds fall into this category. The most common are:
- Diabetic foot ulcers (the most studied type for HBOT)
- Venous stasis ulcers, caused by poor vein circulation in the legs
- Arterial insufficiency ulcers, caused by reduced blood flow from narrowed arteries
- Pressure ulcers and injuries
- Radiation-induced wounds
- Wounds in immunocompromised patients
Standard wound care must come first. This includes debridement (removing dead tissue), compression, and offloading pressure from the wound. HBOT is adjunctive. It works alongside these treatments, not instead of them.
How HBOT Promotes Wound Healing
Chronic wounds are stuck in a state of hypoxia. That means the tissue isn’t getting enough oxygen. Normal blood flow can’t deliver enough oxygen to support the healing process.
HBOT changes that. Inside a pressurized chamber, oxygen dissolves directly into your blood plasma. This bypasses the limitations of your blood vessels and floods the wound tissue with oxygen.
That extra oxygen triggers several healing processes. New connective tissue cells (fibroblasts) start to multiply. New blood vessels grow into the wound through angiogenesis. Collagen production accelerates, rebuilding the structural scaffold of the tissue. And white blood cells regain the killing power they need to control bacterial infection.
The result is a wound environment that can finally begin to heal.
Who Is a Candidate?
Not every non-healing wound responds to HBOT. Patient selection matters a lot.
Your wound care team will first confirm that you’ve tried standard care without success. Then they may order a test called transcutaneous oximetry, or TcPO2. This test measures the oxygen level in the tissue around your wound.
If your TcPO2 improves significantly when you breathe supplemental oxygen, that’s a strong sign your wound tissue is hypoxic and could benefit from HBOT. If blood flow to the area is too compromised, HBOT may not help. The oxygen still needs some way to reach the tissue.
A hyperbaric physician or wound care specialist will evaluate your case. They’ll look at your wound type, its history, and your test results to decide if you’re a good candidate.
See our diabetic wound page if your wound is related to diabetes. That condition has its own specific evidence base for HBOT.
What the Research Shows
The evidence for HBOT in non-healing wounds is well-established. Two widely cited reviews support its use.
Goldman (2009) conducted a systematic review of HBOT for wound healing and limb salvage. The review found that HBOT reduced amputation rates and improved healing outcomes in patients with diabetic foot ulcers and other chronic wounds. (PMID: 19627935)
Londahl (2013) reviewed HBOT as an adjunct treatment specifically for diabetic foot ulcers. The review found clinically meaningful improvements in wound closure rates when HBOT was added to standard care. (PMID: 23992901)
Both reviews support HBOT as a valuable tool when standard care alone isn’t working and the patient is properly selected.
Frequently Asked Questions
What types of wounds respond best to HBOT?
Wounds in hypoxic tissue with adequate arterial supply respond best. TcPO2 testing helps predict who will respond. Diabetic foot ulcers have the strongest and most consistent evidence base.
How do I know if I need HBOT for my wound?
A wound care specialist or hyperbaric physician evaluates your wound, confirms that standard care has been tried first, and may order TcPO2 testing. Ask your wound care team if HBOT is appropriate for your situation.
How many sessions does wound healing take?
Most protocols involve 20 to 40 sessions over 4 to 8 weeks. Your care team will evaluate your response around sessions 20 to 30. If there’s no measurable progress by then, treatment is typically discontinued.
Does insurance cover HBOT for wounds?
Medicare and most commercial insurers cover HBOT for qualifying non-healing wounds. You’ll need documentation showing that standard wound care was tried and failed. See our insurance guide for details on how to get coverage.
References:
- Goldman RJ. Hyperbaric oxygen therapy for wound healing and limb salvage: a systematic review. PM R. 2009;1(5):471-489. PMID: 19627935.
- Londahl M. Hyperbaric oxygen therapy as adjunct treatment of diabetic foot ulcers. Med Clin North Am. 2013;97(5):957-80. PMID: 23992901.
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.