This seems a simple question but in reality it is far more complex than we think.

In long term non-healing wounds one of the common end point is a low oxygen concentration in the wound. This is mainly due to poor circulation in the microvasculature (small blood vessels). So add oxygen and it gets better right?

Well no because that oxygen has to be delivered to the skin from the internal circulation and thats whats missing….so how does HBOT work then?

It actually works in many ways but the main way it works is by creating a large oxygen gradiant between the edges of the wound and the wound itself. This is what happens in a normal acute (immediate) wound such as when you cut yourself. The body notes the large oxygen gradiant and releases vascular growth factors and this establishes new blood vessels in the tissues. In ‘chronic’ long term wounds these bllod vessels then supply the tissues and the skin heals like a normal cut. The vessels remain in place and the wound becomes more resistant to damage and deterioration preventing further ulcers from developing (although if the person has diabetes or another degenerative disease then these vessels will also ultimately fail).

See the graph below and the picture of all the actions of hyperbaric oxygen in treating its indications.

HyperDoc