TL;DR: Non-healing wounds after cancer surgery are a serious complication that can delay life-saving adjuvant treatments and compromise reconstruction outcomes. Hyperbaric oxygen therapy (HBOT) is a well-established adjunctive treatment for complex post-surgical wound healing, particularly for compromised skin grafts, flaps, and wounds in previously irradiated tissue. A 2025 single-institution study of post-mastectomy wound complications reported 100% complete healing with HBOT. This Daffodil Month, we explain how HBOT supports wound healing after cancer surgery, the specific situations where it applies, and how Canadian patients can access treatment.
Estimated reading time: 10 minutes
Why Do Wounds After Cancer Surgery Sometimes Not Heal?
Wound healing complications after cancer surgery are one of the most common reasons oncologic treatment is delayed or disrupted. While most surgical wounds heal uneventfully, cancer patients face several unique risk factors that can interfere with normal tissue repair:
- Prior radiation therapy to the surgical area damages the small blood vessels that supply oxygen needed for healing
- Chemotherapy can suppress bone marrow, reduce circulating growth factors, and impair the immune response
- Compromised blood supply from large resections, tissue expanders, or complex flap reconstructions
- Diabetes, smoking, and advanced age independently slow wound healing
- Poor nutritional status during and after cancer treatment
- Immunosuppression from corticosteroids or targeted cancer therapies
When a wound fails to heal, the consequences extend well beyond the wound itself. Adjuvant radiation or chemotherapy may be delayed. Reconstructive procedures may need to be redone. Infections can develop. Quality of life drops sharply. During Daffodil Month, it is important to know that effective adjunctive treatments exist – and one of the most robustly evidenced is hyperbaric oxygen therapy.
How Does HBOT Support Post-Surgical Wound Healing?
Hyperbaric oxygen therapy (HBOT) is a medical treatment that delivers 100% oxygen at elevated atmospheric pressure, dramatically increasing the amount of oxygen dissolved in blood plasma. This enables oxygen to reach tissue that would otherwise be hypoxic.
For post-surgical wound healing, HBOT works through several complementary mechanisms:
- Angiogenesis: Growth of new blood vessels in the wound bed, restoring perfusion to ischaemic tissue
- Fibroblast activation: Stimulation of collagen-producing cells that rebuild the extracellular matrix
- Antimicrobial action: Direct killing of anaerobic bacteria and enhancement of neutrophil function
- Reduced oedema: Vasoconstriction at elevated oxygen levels decreases swelling in the wound bed
- Stem cell mobilisation: Release of endogenous stem cells that support tissue repair
- Reactive oxygen signalling: Modulation of growth factor expression and wound healing gene activity
A 2026 comprehensive review of HBOT in modern surgical practice examined 38 studies across surgical specialties and confirmed that HBOT improves healing rates, flap survival, and graft uptake across diabetic wounds, reconstructive surgery, and radiation-associated surgical complications. Standard protocols of 2.0 to 2.5 ATA for 60 to 90 minutes over 20 to 40 sessions produced mostly mild, reversible adverse events (Gonzalez Flores et al., 2026).
When Is HBOT Used for Cancer Surgery Wounds?
HBOT has several specific indications within cancer surgery, all of which are recognised under Health Canada’s device licensing framework:
| Clinical Situation | HBOT Role | Evidence Level |
|---|---|---|
| Compromised skin grafts and flaps | Flap salvage after ischaemia or partial necrosis | Strong (Cochrane review) |
| Post-mastectomy flap necrosis | Wound healing and reconstruction salvage | Strong (2025 retrospective, 100% healing) |
| Head and neck reconstruction | Support flaps placed in irradiated tissue | Strong (systematic reviews) |
| Osteoradionecrosis prophylaxis | Before and after tooth extraction in irradiated jaw | Strong (RCTs, guidelines) |
| Non-healing wounds after pelvic surgery | Perineal wound breakdown, fistula healing | Moderate (retrospective studies) |
| Delayed radiation wound breakdown | Treatment of late radiation injury that opens wounds | Strong (Cochrane review) |
Compromised grafts and flaps and delayed radiation injury are both among the 14 conditions recognised under Health Canada’s device licensing framework – which means HBOT for these indications is covered by provincial health plans at hospital-based programmes.
Landmark 2025 Study: Post-Mastectomy Wound Complications
One of the most compelling recent studies on HBOT for cancer surgery wounds was published in the Journal of Plastic, Reconstructive & Aesthetic Surgery. The study reviewed 10 years of experience treating post-mastectomy wound complications at a single large academic institution.
Key findings from 20 patients treated between 2014 and 2024:
- All patients received HBOT at 2.0 ATA in 90-minute sessions
- Median of 30.5 sessions per patient (range 25.5 to 58)
- 65% of patients had received perioperative radiation therapy
- 90% presented with mastectomy flap necrosis or wound dehiscence
- 100% of patients achieved complete wound healing
- Early HBOT initiation significantly correlated with faster healing times (p=0.023)
- Only one patient experienced a transient adverse effect
- All patients were able to continue their planned oncologic therapies