From oxygen biology to surgical outcomes: translating hyperbaric oxygen therapy mechanisms into tissue salvage

Patricia Gómez Roblero; Alfredo Olvera Frangos; Jonathan Mario Salzillo Cardona; Dafne Eunice Hernández León; Alexa Crystal González Herrera; Emilio G. Lazarini; Jose Esteban Manzano Jurado; Brisa Jeanette Hernández Méndez; Jeffrey Barragán Ortega; Diego Ruiz Ruiz; Luis Miguel Canal de Velasco; Aarón González-Espinosa; Manuel Esaú Tamayo Gómez; Alfonso Sandoval Polito; Ashley María Guzmán Velázquez; Joaquín Martínez Rodríguez; José Emiliano González Flores

doi:10.18203/2349-2902.isj20263353

Authors

Patricia Gómez Roblero Universidad Juárez Autónoma de Tabasco, México
Alfredo Olvera Frangos Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Jonathan Mario Salzillo Cardona Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Dafne Eunice Hernández León Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México
Alexa Crystal González Herrera Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México
Emilio G. Lazarini Universidad Autónoma de Baja California, Escuela de Ciencias de la Salud, California, México; PEMEX Central Norte, Departamento de Medicina Interna, México
Jose Esteban Manzano Jurado Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey Campus Ciudad de México, México
Brisa Jeanette Hernández Méndez Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México
Jeffrey Barragán Ortega Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México
Diego Ruiz Ruiz Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Luis Miguel Canal de Velasco Escuela de Medicina, Universidad Panamericana, Ciudad de México, México
Aarón González-Espinosa Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
Manuel Esaú Tamayo Gómez Hospital General de Especialidades “Dr. Javier Buenfil Osorio”, Campeche, México
Alfonso Sandoval Polito Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey Campus Ciudad de México, México
Ashley María Guzmán Velázquez Escuela de Medicina, Universidad Regional del Sureste (URSE), Oaxaca, México
Joaquín Martínez Rodríguez Escuela de Medicina, Universidad Regional del Sureste (URSE), Oaxaca, México
José Emiliano González Flores Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey Campus Ciudad de México, México

DOI:

https://doi.org/10.18203/2349-2902.isj20263353

Keywords:

Hyperbaric oxygen therapy, Tissue oxygenation, Wound healing, Angiogenesis, Surgical outcomes, Ischemic injury, Translational medicine

Abstract

Hyperbaric oxygen therapy (HBOT) has emerged as a valuable adjunct in the management of ischemic and complex surgical wounds; however, its clinical application remains heterogeneous and often empirically driven. Despite growing evidence supporting its efficacy, a critical gap persists between the mechanistic understanding of HBOT and its integration into surgical decision-making. This systematic review aimed to synthesize current evidence on the biological mechanisms underlying HBOT and translate these mechanisms into clinically relevant outcomes. A structured search of PubMed/MEDLINE, Scopus, and Web of Science identified 312 records, of which 30 studies were included in the final qualitative synthesis. The evidence identified enhanced oxygen diffusion, angiogenesis and neovascularization, inflammatory modulation, antimicrobial activity, and cellular regeneration as interconnected mechanisms underlying the therapeutic effects of HBOT. Across surgical contexts, these mechanisms were associated with improved wound healing, enhanced tissue viability, infection control, reduced tissue necrosis, and lower amputation risk in selected clinical settings. Considerable heterogeneity was identified in treatment timing, pressure, session duration, frequency, and total number of sessions, with therapeutic responsiveness appearing to depend on the underlying pathophysiology, stage of tissue injury, and residual tissue viability. Based on these findings, a translational framework linking tissue hypoxia, ischemia, inflammation, infection, and impaired regeneration with specific HBOT-mediated mechanisms and expected clinical outcomes is proposed. Collectively, the findings support conceptualizing HBOT as a targeted adjunctive therapy rather than a universally applicable intervention, emphasizing mechanism-driven patient selection, appropriate treatment timing, and individualized therapeutic strategies to optimize its role in surgical tissue salvage and wound healing.

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