Why Some Wounds Won’t Heal and Where Hyperbaric Oxygen Therapy Fits In

By Your Health Magazine Contributor

Your Health Magazine Contributor

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Why Some Wounds Won’t Heal and Where Hyperbaric Oxygen Therapy Fits In

Most of us never think twice about a cut or a scrape. You clean it, cover it, and a week or two later it’s gone. Your body handles the rest without asking for anything.

But for millions of people, it doesn’t work that way. A small blister on the foot turns into an open sore that’s still there three months later. A surgical incision keeps reopening. A patient who had radiation years ago finds the skin in that area just won’t knit back together. Each week brings new dressings, new appointments, and the same quiet worry: why isn’t this getting better?

If you or someone you love has been there, you know how draining it is, physically and emotionally. The good news is that doctors understand a lot more today about why some wounds stall. And they have more tools for stubborn wounds, including one that surprises a lot of people: breathing pure oxygen inside a pressurized chamber.

Let’s look at what’s going on beneath the surface of a wound that won’t heal, and where hyperbaric oxygen therapy fits in.

Why some wounds get “stuck”

Healing isn’t one event. It’s a sequence: the body stops the bleeding, cleans up damaged tissue, builds new tissue, and then strengthens it over time. Each step needs fuel, and one of the most important fuels is oxygen.

Cells that rebuild skin and blood vessels are hungry. They need a steady oxygen supply to make collagen, fight off bacteria, and grow the tiny new capillaries that feed fresh tissue. When oxygen runs short, the whole process slows down or stops partway through. Doctors often call these chronic or non-healing wounds. A common rule of thumb is a wound that hasn’t made real progress in about four to six weeks.

So what cuts off the oxygen? Usually it’s one or more of these:

• Diabetes. High blood sugar over many years damages blood vessels and nerves. Less blood reaches the feet, and nerve damage means people may not feel a small injury until it’s already serious. This is why diabetic foot ulcers are among the most common stubborn wounds.
• Poor circulation. Peripheral artery disease and vein problems both reduce how much oxygen-rich blood reaches the skin, especially in the lower legs.
• Radiation damage. Radiation therapy can save lives, but it can also scar small blood vessels in the treated area. Months or even years later, that tissue may struggle to heal after a minor injury or surgery.
• Infection. Bacteria compete with healing cells for oxygen. Some infections also thrive in low-oxygen tissue, which keeps the cycle going.
• Pressure and immobility. Constant pressure on one spot, like a heel or tailbone, squeezes the blood vessels closed. That’s how pressure sores form in people who spend long periods in a bed or wheelchair.

Age, smoking, poor nutrition, and certain medications can make all of this worse. In many cases it’s a combination, which is why a stubborn wound usually needs more than a better bandage.

How hyperbaric oxygen therapy works

If a lack of oxygen is part of the problem, the obvious question is whether you can just deliver more of it. That’s the basic idea behind hyperbaric oxygen therapy, or HBOT.

During a session, you breathe 100% oxygen inside a chamber where the air pressure is raised to roughly two to three times normal. Under that pressure, your lungs can take in far more oxygen than they could on a normal breath. The extra oxygen dissolves directly into your blood plasma. That means it can reach tissue that red blood cells struggle to get to because the vessels there are narrowed or damaged.

The National Library of Medicine’s MedlinePlus guide to hyperbaric oxygen therapy puts the chamber pressure at about 2.5 times normal. It notes that the extra oxygen can improve tissue oxygen supply, reduce swelling, and help control infection.

Researchers point to a few ways the extra oxygen may act on tissue:

• Oxygen levels. Oxygen in the wound bed rises during a session, and healing cells rely on oxygen to do their work.
• New capillaries. Some studies report the growth of new capillaries, a process called angiogenesis.
• Infection. White blood cells use oxygen to kill bacteria, which is why oxygen levels matter in infected tissue.
• Swelling. Higher oxygen levels narrow blood vessels slightly, which researchers think may reduce swelling.

It’s worth being clear about one thing: HBOT isn’t a magic fix, and it doesn’t replace good wound care. When doctors use it, it’s one part of a full plan that might include cleaning and debriding the wound, controlling blood sugar, taking pressure off the area, and treating any infection.

Wound care is also one of the better-established uses of HBOT. MedlinePlus lists wounds that haven’t healed with other treatment, such as diabetic foot ulcers, along with radiation injury, skin grafts, and crush injuries, among the conditions it’s used for. Be careful with clinics that promise HBOT can cure a long list of unrelated illnesses. Ask your doctor what the evidence says for your specific wound.

When do doctors consider it?

HBOT isn’t for every cut or bruise. It’s usually considered when a wound has been around for weeks or months and standard care hasn’t moved it forward. People who often ask their doctor about it include:

• People with diabetes who have a foot ulcer that won’t close
• Cancer survivors with tissue damage from past radiation treatment
• Patients whose skin graft or surgical flap isn’t taking well
• People recovering from crush injuries or serious burns
• People with bone infections that have not responded to standard treatment or certain necrotizing soft-tissue infections

If you’re not sure whether your situation fits, one option is to consult a wound care specialist or a hyperbaric oxygen therapy center. A clinician can look at the wound, review your health history, and discuss whether HBOT may be appropriate.

What a session actually feels like

A lot of people picture something scary. In reality, it’s pretty calm. You lie down in a clear chamber or sit in a larger room with other patients. The pressure slowly rises, and you’ll feel fullness in your ears, a bit like descending in an airplane. Swallowing or yawning usually clears it.

Once you’re at pressure, you just breathe normally. Many people nap, listen to music, or watch a show. A session typically lasts about 90 minutes to two hours, and staff monitor you the whole time.

The bigger commitment is the number of sessions. Wounds don’t heal overnight, and treatment for a chronic wound can take 40 sessions or more, usually five days a week. That’s a real time investment, so it helps to plan ahead with work, family, and transportation.

Risks to know about

HBOT is a medical treatment and isn’t risk-free, which is why it should only be done under proper medical supervision. Commonly reported side effects include ear pain or pressure, sinus discomfort, and temporary changes in vision. Less often, the pressure can injure the middle ear. People with diabetes who use insulin may see their blood sugar drop during treatment, so their care team will usually check levels before and after. Rarely, oxygen toxicity can cause a seizure.

That’s why it matters where you go. Look for a center with trained staff, a physician overseeing treatment, and a clear screening process before you start.

The bottom line

A wound that won’t heal is more than an inconvenience. It can affect your mobility, your sleep, your mood, and in serious cases, your long-term health. If you’ve been dealing with one for more than a month, don’t just keep changing the dressing and hoping. Ask your doctor why it’s stuck.

Often the answer comes down to blood flow and oxygen. When that’s the case, hyperbaric oxygen therapy is one option worth asking about. It isn’t a cure-all, it doesn’t replace standard wound care, and whether it fits your situation is a decision for you and your care team.

This article is for general information only and isn’t medical advice. Talk to your doctor or a wound care specialist about what’s right for your situation.