Hyperbaric oxygen therapy promotes healing in chronic non-healing wounds, particularly diabetic foot ulcers, by stimulating angiogenesis, enhancing white-blood-cell antimicrobial activity, and supporting fibroblast and collagen synthesis in hypoxic tissue. Problem wounds are the most common non-emergency hyperbaric indication in Canada and are recognised by Health Canada as one of the 14 conditions for which provincial health insurance covers HBOT at hospital-based programmes.
Quick Answer
Does HBOT help enhancement of healing in selected problem wounds? Hyperbaric oxygen therapy promotes healing in chronic non-healing wounds, particularly diabetic foot ulcers, by stimulating angiogenesis, enhancing white-blood-cell antimicrobial activity, and supporting fibroblast and collagen synthesis in hypoxic tissue. Problem wounds are the most common non-emergency hyperbaric indication in Canada and are recognised by Health Canada as one of the 14 conditions for which provincial health insurance covers HBOT at hospital-based programmes.
Problem wounds are chronic wounds that have failed to progress through the normal healing process despite four to six weeks of appropriate standard care. They cluster around four clinical patterns: diabetic foot ulcers (the largest single category, affecting approximately 15 percent of people living with diabetes during their lifetime), venous stasis ulcers, arterial insufficiency ulcers, and chronic post-surgical or post-traumatic wounds.
The common physiological feature across these patterns is local tissue hypoxia. Healthy wound healing requires tissue oxygen tensions of 30 to 50 mmHg for fibroblast collagen synthesis, neutrophil bacterial killing, and capillary sprouting. Chronic wounds frequently sit in tissue with oxygen tensions of 5 to 15 mmHg because of micro- and macro-vascular disease, infection, edema, or radiation damage. The wound bed cannot generate the cellular activity needed to close the wound, regardless of dressing choice or topical therapy.
Diabetic foot ulcers carry particular weight in Canadian health policy because they are the leading cause of non-traumatic lower-limb amputation in people with diabetes. The progression from ulcer to infection to amputation is preventable in most cases when healing is restored before infection invades bone or fascia. Hyperbaric oxygen therapy is one of the few adjunctive treatments shown in randomised trials to alter that trajectory in selected patients.
Hyperbaric oxygen therapy directly addresses tissue hypoxia, the limiting factor in chronic wound healing. Inside the chamber at 2.0 to 2.4 atmospheres absolute (ATA) on 100 percent oxygen, plasma oxygen content rises 10- to 15-fold compared with breathing room air at sea level. Tissue oxygen tensions in the wound bed climb from a baseline of 5 to 15 mmHg into the 200 to 400 mmHg range during each session.
The biological response unfolds over a course of treatments rather than in a single session. Repeated intermittent hyperoxia stimulates the release of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (SDF-1), recruiting bone-marrow-derived endothelial progenitor cells to the wound margin. Over twenty to thirty sessions, capillary density at the wound bed increases substantially, and the new vessels persist long after the treatment course ends.
In parallel, HBOT restores neutrophil oxidative-burst activity, the oxygen-dependent mechanism that kills bacteria in infected tissue. It enhances fibroblast proliferation and collagen cross-linking, supports keratinocyte migration across the granulating wound bed, and improves the antibiotic activity of certain agents (notably aminoglycosides and fluoroquinolones) that are oxygen-dependent for tissue uptake. The net effect is a wound bed that can resume normal healing biology after weeks or months of stalled progress.
Typical Treatment Protocol
Standard course is 2.0 to 2.4 ATA for 90 to 120 minutes per session, delivered five days per week for 20 to 40 total sessions (typically 4 to 8 weeks). Transcutaneous oximetry (TcPO2) measurements taken before treatment and during the first one or two sessions help predict response: in-chamber TcPO2 values rising above 200 mmHg are associated with a high probability of healing, while values failing to rise above 50 mmHg suggest the wound is unlikely to respond. Some Canadian programmes use the in-chamber TcPO2 result to confirm the treatment plan; others proceed empirically and re-evaluate at session 20.
Level A - Strong Evidence
Supported by high-quality RCTs and systematic reviews
The Löndahl et al. RCT (Diabetes Care 2010, 94 patients with chronic diabetic foot ulcers) showed 52 percent complete healing in the HBOT arm versus 29 percent with placebo at one year, with a number-needed-to-treat of approximately 4 for complete healing.
The Kranke et al. Cochrane Review (Cochrane Database of Systematic Reviews 2015, 12 RCTs, 577 participants) concluded that HBOT significantly improves short-term healing rates for diabetic foot ulcers but found insufficient evidence on long-term outcomes or amputation reduction in the pooled analysis.
The Fedorko et al. Canadian RCT (Diabetes Care 2016, 103 patients) failed to show a difference in major amputation rates between HBOT and sham treatment over 12 weeks. This negative trial is important to cite alongside the Cochrane evidence and remains a topic of ongoing methodological discussion in the literature.
In-chamber transcutaneous oximetry (TcPO2) above 200 mmHg during the first one or two sessions is the strongest single predictor of which patients will heal. Patients with TcPO2 values below 50 mmHg in-chamber are unlikely to benefit and should generally not proceed with the full course.
Cost-effectiveness analyses (Chuck 2008, Margolis 2013, others) have shown HBOT for diabetic foot ulcers can be cost-effective when factoring in the reduction in major amputation rates and the substantial life-time costs of below-knee or above-knee amputation, including prosthetics, rehabilitation, and reduced quality of life.
The 2025-2026 systematic-review and network-meta-analysis literature (multiple papers in our research database) generally supports HBOT as one of several effective adjunctive therapies for diabetic foot ulcers, alongside negative-pressure wound therapy and bioengineered skin substitutes. The strongest evidence remains for hypoxic wounds where standard care has failed.
Highest-evidence-tier studies tagged to this condition in the Canada Hyperbarics research database, ranked by evidence tier (1 = meta-analysis or RCT, 2 = cohort, 3 = case series), most recent first.
Int Wound J · 2026 · RCT
J Wound Care · 2026 · Meta-Analysis
PeerJ · 2025 · Meta-Analysis
Studies in our database that include a ClinicalTrials.gov registration. Trial registration is a marker of methodological rigour because the protocol, primary outcome, and analysis plan are deposited before enrolment begins.
Heliyon · 2024 · Clinical Study · PMID 39687107
Free Radic Res · 2024 · RCT · PMID 39425927
BMJ open · 2023 · RCT · PMID 37230523
TheScientificWorldJournal · 2018 · Pilot Study · PMID 30158840
Cureus · 2016 · Retrospective Study · PMID 27909641
Most patients are referred to a hospital hyperbaric programme by their family physician, wound-care specialist, or vascular surgeon after four to six weeks of conservative care has failed to produce measurable progress. The hyperbaric medicine team confirms eligibility (the wound classification, the underlying vascular status, and the absence of absolute contraindications), takes baseline transcutaneous oximetry measurements at the wound margin and a reference site, and books the treatment course.
Daily sessions begin within one to two weeks of the consultation. You change into cotton scrubs (no synthetic fabrics, no skin lotions, no jewellery), enter the chamber for pressurisation over five to ten minutes, breathe pure oxygen during the treatment phase, and decompress back to surface pressure over another five to ten minutes. The total time on-site is typically two to three hours per visit including check-in and dressing changes.
Wound progress is measured weekly. Most responders show measurable wound area reduction by session ten to fifteen, with closure or near-closure by the end of the course. Patients with diabetic foot ulcers often continue specialised wound dressings between hyperbaric sessions and after the course ends. Side effects, when they occur, are usually limited to ear barotrauma (manageable with pressure-equalisation techniques), temporary near-sightedness (usually resolves within a few weeks of stopping), and mild fatigue.
Problem wounds are the most common non-emergency hyperbaric indication treated under provincial health insurance at the 11 hospital-based hyperbaric programmes in Canada. Ontario (OHIP) covers treatment at the three hospital programmes (Toronto General / UHN, Hamilton General Hospital, The Ottawa Hospital). Select eligible Independent Health Facilities (IHFs) may also bill OHIP for approved indications, with eligibility varying by facility and indication. Confirm directly with the IHF before booking.
Alberta Health (AHCIP) covers treatment at the two hospital programmes: Misericordia Community Hospital in Edmonton (operated by Covenant Health) and the Foothills Medical Centre / Arthur J.E. Child Comprehensive Cancer Centre in Calgary (operated by Alberta Health Services). The Alberta hospital billing code for HBOT detention time is 13.99I (per 15 minutes). CPSA accreditation of private hyperbaric clinics is a safety and quality standard; CPSA accreditation alone does not grant Alberta Health billing eligibility.
British Columbia (MSP) covers treatment at Vancouver General Hospital's Leon Judah Blackmore Pavilion, the only hospital hyperbaric chamber in the province. Quebec (RAMQ) covers treatment at Hôpital du Sacré-Cœur de Montréal and Hôtel-Dieu de Lévis. Nova Scotia (MSI), Newfoundland and Labrador (MCP), and Saskatchewan also cover hospital-delivered treatment, with caveats around current chamber availability in Saskatchewan since the 2021 Wigmore Hospital staffing disruption.
For patients in provinces or territories without an in-province hospital programme (Manitoba, New Brunswick, Prince Edward Island, Yukon, Northwest Territories, Nunavut), publicly funded HBOT is accessed through inter-provincial referral coordinated by the family physician or specialist. The most common destinations are Misericordia Edmonton (for prairie and territorial patients) and the Ontario hospital programmes. Inter-provincial billing arrangements typically cover the medically necessary treatment cost; travel and accommodation are usually the patient's responsibility unless the home province operates a medical-travel assistance programme.
Private hyperbaric clinics across Canada also offer problem-wound treatment on a self-pay basis, typically at $175 to $350 per session. Some private extended health plans cover specific indications when accompanied by a physician referral; confirm with your plan administrator before booking.
Hyperbaric oxygen therapy for the 14 Health Canada-recognised conditions, including Enhancement of Healing in Selected Problem Wounds, is delivered at the 11 hospital hyperbaric programmes located in seven provinces (Ontario, Quebec, British Columbia, Alberta, Nova Scotia, Newfoundland and Labrador, and Saskatchewan). The six provinces and territories without an in-province hospital programme (Manitoba, New Brunswick, Prince Edward Island, Yukon, Northwest Territories, and Nunavut) route patients to the nearest receiving hospital programme. Use the links below for province-specific coverage, referral pathway, and emergency routing details.
Hospital + Private
OHIP (Ontario Health Insurance Plan)
Hospital Only
MSP (Medical Services Plan)
Hospital + Private
Alberta Health / AHCIP
Hospital Only
RAMQ
Disrupted
Saskatchewan Health Authority
No Hospital Chamber
Manitoba Health
Hospital Only
MSI (Medical Services Insurance)
No Hospital Chamber
Medicare NB
Hospital Only
MCP (Medical Care Plan)
Out-of-Province Referral
Health PEI
Out-of-Province Referral
Yukon Health and Social Services
Out-of-Province Referral
NWT Health and Social Services
Out-of-Province Referral
Nunavut Department of Health
For acute or emergency presentations of Enhancement of Healing in Selected Problem Wounds, call 911 first. The receiving emergency department coordinates urgent transfer to the nearest hospital hyperbaric programme through the relevant provincial transfer network (CritiCall Ontario at 1-800-668-4357, BC Patient Transfer Network, EHS Nova Scotia, or equivalent). For diving-related emergencies, the Divers Alert Network (DAN) emergency hotline is 1-919-684-9111.
Untreated pneumothorax is the only absolute contraindication, because trapped intrathoracic air expands on decompression and can cause tension pneumothorax. The pneumothorax must be drained with a chest tube before chamber entry. Concurrent treatment with bleomycin (a chemotherapy agent that can cause oxygen-induced pulmonary fibrosis) and disulfiram (which interferes with antioxidant defences) are also contraindicated. Relative contraindications, weighed against expected benefit on a per-patient basis, include severe chronic obstructive pulmonary disease with bullous lung disease (where air trapping increases pneumothorax risk), uncontrolled seizure disorder (HBOT can lower the seizure threshold in susceptible patients), claustrophobia (manageable in monoplace chambers and with behavioural strategies), recent middle-ear or sinus surgery, untreated dental abscesses, and uncontrolled hypertension. Pregnancy is not a contraindication for the recognised emergency indications, but elective HBOT during pregnancy is generally deferred unless clinically necessary. Cardiac function should be assessed in patients with congestive heart failure because the increase in plasma oxygen content can transiently increase left-ventricular afterload.
A standard course is 20 to 40 sessions delivered five days per week, typically over four to eight weeks. Each session lasts 90 to 120 minutes inside the chamber, with another 30 to 45 minutes for check-in, gowning, and dressing changes. Most patients see measurable wound area reduction by session 10 to 15, with full course response evaluated at the end.
No. HBOT works best in hypoxic wound beds where inadequate oxygen supply is the primary barrier to healing. Pre-treatment transcutaneous oximetry (TcPO2) and the in-chamber TcPO2 response during the first one or two sessions are used to predict whether a patient will respond. Wounds with values rising above 200 mmHg in-chamber respond best; wounds where values fail to rise above 50 mmHg are unlikely to benefit.
Yes, at hospital-based hyperbaric programmes under provincial health insurance. OHIP covers treatment at the three Ontario hospital programmes (Toronto General, Hamilton General, The Ottawa Hospital), with select eligible IHFs also able to bill OHIP for approved indications. Alberta Health (code 13.99I) covers treatment at Misericordia Edmonton and Foothills/AJECCC Calgary. MSP covers Vancouver General Hospital. RAMQ covers the two Quebec hospital programmes. MSI, MCP, and Saskatchewan Health each cover their respective hospital programmes. Private clinic treatment is typically self-pay.
Some evidence suggests HBOT can reduce major amputation rates when added to comprehensive wound care, particularly the Löndahl 2010 RCT and several systematic reviews. However, the Canadian Fedorko 2016 RCT did not show a difference at 12 weeks. The current consensus is that HBOT can support healing in well-selected diabetic foot ulcers, especially when standard care has failed and the wound bed is responsive on pre-treatment TcPO2 testing.
Speak with your family physician, endocrinologist, or wound-care specialist. They will document four to six weeks of unsuccessful standard care (offloading, debridement, infection control, glycaemic optimisation), assess vascular status with ankle-brachial index or transcutaneous oximetry, and refer you to the nearest hospital hyperbaric programme. The receiving programme typically schedules a consultation within one to four weeks, with treatment beginning shortly after if you meet eligibility criteria.
You change into cotton scrubs, enter the chamber, and lie down (in a monoplace) or sit in a recliner (in a multiplace with multiple patients). Pressurisation takes five to ten minutes and feels like the descent in an aircraft. Most people clear their ears with the same technique used in flying. During the 90 to 120 minute treatment phase you breathe pure oxygen, often through a hood or mask, while reading, watching a screen, or sleeping. Decompression takes another five to ten minutes. The most common sensation during a session is a feeling of warmth.
The most common side effect is ear barotrauma during pressurisation, which is managed with pressure-equalisation techniques and resolves between sessions. Other relatively common effects are temporary near-sightedness (myopia) during the course (vision usually returns to baseline within a few weeks of stopping), fatigue, and rare confinement anxiety. Serious complications including pneumothorax, oxygen toxicity seizures, and cardiac decompensation are uncommon at the standard 2.0 to 2.4 ATA pressures used for problem wounds.
Yes. HBOT is an adjunct to, not a replacement for, comprehensive wound care. Throughout the course, you continue offloading (a healing shoe or contact cast for plantar diabetic foot ulcers), specialised dressings, debridement, infection management, and glycaemic control. Hyperbaric programmes coordinate closely with your home wound-care team.
Private hyperbaric clinics typically charge $175 to $350 per session depending on chamber type, duration, and clinical complexity. A full 30-session course can therefore total $5,000 to $10,500 out-of-pocket. Some private extended health plans cover specific indications when accompanied by a physician referral; confirm with your plan administrator before booking. Coverage at hospital-based programmes is fully publicly funded for the recognised indications.
No. Wounds caused primarily by macrovascular disease (significant arterial blockage) need vascular reconstruction or angioplasty before or instead of HBOT. The hyperbaric medicine team works with vascular surgery to identify wounds where the vascular status is adequate and HBOT can address residual microvascular hypoxia. HBOT is also typically combined with revascularisation in patients who have both macrovascular disease and a hypoxic wound bed.
Bleomycin chemotherapy is an absolute contraindication; the treating oncology team should be consulted about the timing of HBOT relative to bleomycin administration. Disulfiram (used for alcohol-use disorder) interferes with antioxidant defences and is also contraindicated. Insulin doses may need adjustment during the treatment course because hyperbaric oxygen modestly improves insulin sensitivity. Discuss your full medication list with the hyperbaric medicine team at intake.
Yes, in nearly all cases. There is no general restriction on driving after a routine outpatient HBOT session. Some patients feel mild fatigue for the first several sessions, in which case a passenger driver or alternate transport is reasonable until you know how you respond.
The strongest evidence base is in diabetic foot ulcers, which is also the largest single category in Canadian hyperbaric practice. Evidence for venous stasis ulcers and arterial insufficiency ulcers is more limited but supportive in selected hypoxic cases. Treatment decisions for these wound types are made by the hyperbaric medicine team in coordination with the referring wound-care specialist, often using TcPO2 to confirm the wound bed is hyperoxia-responsive.
They target different mechanisms and are often combined rather than chosen between. Negative-pressure wound therapy (NPWT) uses sub-atmospheric pressure at the wound surface to remove exudate, reduce edema, and encourage granulation tissue formation. HBOT addresses local tissue hypoxia by delivering oxygen at depth. Recent network meta-analyses suggest both interventions can be effective adjuncts and that combined use is reasonable in selected patients with deep, hypoxic, and exudative wounds.
The Canada Hyperbarics verified directory lists all 11 hospital programmes alongside their phone numbers, websites, and current chamber status. The directory and detailed coverage pages for each province (Ontario, British Columbia, Alberta, Quebec, Saskatchewan, Manitoba, Nova Scotia, New Brunswick, Newfoundland and Labrador, Prince Edward Island, and the three territories) are available at canadahyperbarics.ca/facilities/ and canadahyperbarics.ca/hbot-coverage-canada/.