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. 2013 Dec 16;2013(12):CD008059.
doi: 10.1002/14651858.CD008059.pub3.

Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

Anne Eskes  1 , Hester Vermeulen, Cees Lucas, Dirk T Ubbink
Affiliations

Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

Anne Eskes et al. Cochrane Database Syst Rev. .

Abstract

Background: Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear.

Objectives: To determine the effects of HBOT on the healing of acute surgical and traumatic wounds.

Search methods: We searched the Cochrane Wounds Group Specialised Register (searched 9 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week 5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08, 2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013).

Selection criteria: Randomised controlled trials (RCTs) comparing HBOT with other interventions such as dressings, steroids, or sham HOBT or comparisons between alternative HBOT regimens.

Data collection and analysis: Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author.

Main results: Four trials involving 229 participants were included. The studies were clinically heterogeneous, which precluded a meta-analysis.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery) reported no significant difference between graft survival (no data available). A third trial (36 participants with crush injuries) reported significantly more wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The fourth trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many of the predefined secondary outcomes of the review were not reported. All four trials were at unclear or high risk of bias.

Authors' conclusions: There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma, these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed.

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Conflict of interest statement

None of the authors have any conflict of interest.

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 HBOT compared with usual care, Outcome 1 Complete survival (defined as at least 95% take) at day 7.
2.1
2.1. Analysis
Comparison 2 HBOT compared with sham HBOT, Outcome 1 Complete healing.
2.2
2.2. Analysis
Comparison 2 HBOT compared with sham HBOT, Outcome 2 Time to healing (days).
2.3
2.3. Analysis
Comparison 2 HBOT compared with sham HBOT, Outcome 3 Adverse effects (additional surgical procedures).
2.4
2.4. Analysis
Comparison 2 HBOT compared with sham HBOT, Outcome 4 Adverse effects (tissue necrosis).
2.5
2.5. Analysis
Comparison 2 HBOT compared with sham HBOT, Outcome 5 Amputations.
2.6
2.6. Analysis
Comparison 2 HBOT compared with sham HBOT, Outcome 6 Length of hospital stay.
3.1
3.1. Analysis
Comparison 3 HBOT compared with dexamethasone or heparin, Outcome 1 Complete healing HBOT vs dexamethasone.
3.2
3.2. Analysis
Comparison 3 HBOT compared with dexamethasone or heparin, Outcome 2 Complete healing HBOT vs heparin.
See this image and copyright information in PMC

Update of

References

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