HYPERBARIC OXYGEN THERAPY IN ACUTE TRAUMATIC ISCHEMIC INJURIES OF THE EXTREMITIES: MECHANISMS, TIMING, AND CLINICAL EVIDENCE - A NARRATIVE REVIEW

Remigiusz Piliński; Weronika Bukwald; Magdalena  Rumin; Natalia Muzyka; Amanda Abramowicz; Gabriela Panek; Adam Prusek; Dominika Gosztyła; Jakub Giersz; Kacper Kość

doi:10.31435/ijitss.2(50).2026.6083

Authors

Remigiusz Piliński Military Institute of Aviation Medicine, Zygmunta Krasińskiego 54/56, 01-755 Warsaw, Poland https://orcid.org/0009-0003-5543-7058
Weronika Bukwald Military Institute of Medicine – National Research Institute, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0001-5651-4815
Magdalena Rumin Military Institute of Aviation Medicine, Zygmunta Krasińskiego 54/56, 01-755 Warsaw, Poland https://orcid.org/0009-0009-4281-8971
Natalia Muzyka Military Institute of Medicine – National Research Institute, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0000-3164-216X
Amanda Abramowicz Military Institute of Aviation Medicine, Zygmunta Krasińskiego 54/56, 01-755 Warsaw, Poland https://orcid.org/0009-0004-6674-0594
Gabriela Panek Military Institute of Aviation Medicine, Zygmunta Krasińskiego 54/56, 01-755 Warsaw, Poland https://orcid.org/0009-0004-3588-5336
Adam Prusek 5th Military Clinical Hospital with Polyclinic, Wrocławska 1/3, 30-901 Kraków, Poland https://orcid.org/0009-0004-3343-2835
Dominika Gosztyła 10th Military Clinical Hospital with Polyclinic, Powstańców Warszawy 5, 85-681 Bydgoszcz, Poland https://orcid.org/0009-0007-9156-3499
Jakub Giersz 4th Military Clinical Hospital with Polyclinic, Weigla 5, 53-114 Wrocław, Poland https://orcid.org/0009-0002-6374-1730
Kacper Kość Kazimierz Pułaski University of Technology and Humanities, Jacka Malczewskiego 29, 26-600 Radom, Poland https://orcid.org/0009-0000-5344-8667

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.6083

Keywords:

Hyperbaric Oxygen Therapy, Crush Injury, Compartment Syndrome, Ischemia-Reperfusion Injury, Limb Salvage, Traumatic Ischemia

Abstract

Background: Acute traumatic ischemic injuries of the extremities, including crush injuries, compartment syndrome, and vascular trauma, remain associated with substantial morbidity, tissue necrosis, and risk of limb loss despite advances in surgical and reconstructive management. Increasing evidence suggests that ischemia-reperfusion injury and microvascular dysfunction contribute substantially to secondary tissue damage following severe extremity trauma.

Aim: The aim of this narrative review was to summarize and critically evaluate the current evidence regarding hyperbaric oxygen therapy (HBOT) in acute traumatic ischemic injuries of the extremities, with particular emphasis on pathophysiology, biological mechanisms, treatment timing, and clinical outcomes.

Methods: A narrative literature review was conducted using PubMed/MEDLINE and Google Scholar databases. Randomized clinical trials, observational studies, systematic reviews, and mechanistic studies evaluating HBOT in crush injuries, compartment syndrome, traumatic ischemia, and severe extremity trauma were analyzed.

Results: Available evidence suggests that adjunctive HBOT may reduce tissue necrosis, wound-related complications, edema formation, and repeated surgical procedures in selected patients with severe traumatic ischemic injuries. The most consistent findings involved preservation of marginally viable tissue and attenuation of secondary ischemic progression rather than definitive prevention of amputation. Experimental studies additionally demonstrated improved tissue oxygenation, modulation of inflammatory activation, and support of microvascular perfusion.

Conclusions: HBOT appears to represent a promising tissue-preserving adjunct in selected patients with acute traumatic ischemic injuries of the extremities. However, current evidence remains limited by methodological heterogeneity and relatively small study populations.

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