Problem Wound Management with HBOT

Integrated chronic wound management programme combining hyperbaric oxygen therapy with specialist wound review. Targets diabetic foot ulcers, radiation-induced tissue damage, refractory osteomyelitis, and other problem wounds resistant to conventional treatment.

The SGH Problem Wound Management programme pairs hyperbaric oxygen therapy with dedicated wound care expertise to address complex, non-healing wounds that have failed to respond adequately to conventional treatment. Managed by specialist physicians and wound care nurses within Singapore General Hospital, this programme is designed for patients with wounds that are clinically stalled — where tissue ischaemia, infection, radiation damage, or underlying metabolic conditions such as diabetes are preventing normal healing. Hyperbaric oxygen therapy is a cornerstone of the programme's mechanism of action. Breathing 100% oxygen at elevated atmospheric pressure (2 to 3 ATA) raises tissue oxygen tension to levels far beyond what breathing room air at sea level can achieve. This hyperoxic environment stimulates fibroblast proliferation, collagen synthesis, angiogenesis (new blood vessel formation), and immune cell bactericidal activity — all of which are critical components of the wound healing cascade. For radiation-damaged tissue, HBOT also promotes revascularisation in hypoxic irradiated zones, which are otherwise essentially non-viable. The primary wound types managed in this programme include diabetic foot ulcers at high risk of amputation, venous stasis ulcers refractory to compression therapy, radiation tissue injury (including osteoradionecrosis of the jaw following head and neck radiotherapy, and radiation cystitis or proctitis), refractory osteomyelitis where bone infection has failed to clear with antibiotics and surgery, compromised skin grafts and flaps in post-surgical patients, and crush injuries or traumatic wounds with marginal vascularity. Each patient admitted to the programme undergoes a formal wound assessment and is presented at a multidisciplinary team meeting involving surgeons, physicians, wound nurses, and — where relevant — orthopaedic, plastic, or vascular specialists. An individualised HBOT course is prescribed, typically 20 to 40 sessions for chronic wound indications, delivered daily on weekdays. Wound progress is monitored throughout the course with photographic documentation and clinical measurement. The integration of HBOT within SGH's broader medical ecosystem means that patients can receive concurrent surgical, systemic, and nutritional interventions alongside their hyperbaric sessions, rather than HBOT being delivered in isolation. This coordinated approach reflects international best-practice guidelines from the Undersea and Hyperbaric Medical Society (UHMS) and the European Committee for Hyperbaric Medicine (ECHM).