Adjunctive hyperbaric oxygen therapy in high-risk oculoplastic reconstructions requiring graft-based surgery: a retrospective case series.

Abstract

Purpose: To evaluate the postoperative healing course and clinical outcomes of high-risk oculoplastic reconstructions requiring graft-based surgery, in which adjunctive hyperbaric oxygen therapy (HBOT) was used to support wound healing.

Methods: This retrospective case series included 11 patients who underwent oculoplastic surgery with graft-based reconstruction and were considered at high risk for delayed healing and/or tissue compromise. Indications for surgery were orbital implant (sphere) exposure repair (n = 5), cicatricial entropion (n = 1), necrotizing scleritis (n = 1), tissue loss following trauma (n = 1), wound dehiscence and infection after lower eyelid blepharoplasty (n = 1), orbital cellulitis following endophthalmitis and evisceration after cataract surgery (n = 1), and delayed wound healing after dermolipoma excision (n = 1). All patients received graft-based surgical management with adjunctive HBOT. Demographic data, culture results, number of HBOT sessions, and recovery time were analyzed. Patients were evaluated according to HBOT exposure (10 vs. 20 sessions).

Results: All patients underwent graft-supported surgical repair in the setting of anticipated difficult healing. Culture growth was detected in 5 patients. Clinical stabilization and wound closure were achieved without the need for additional major reconstructive procedures in most cases. Patients receiving 20 HBOT sessions had a longer observed mean recovery time compared with those receiving 10 sessions (82.6 vs. 40.9 days; p = 0.032).

Conclusion: In a heterogeneous cohort of high-risk oculoplastic reconstructions requiring grafting-including orbital implant exposure repair and complex inflammatory, infectious, or traumatic etiologies-adjunctive HBOT was used as a supportive modality and was associated with acceptable healing outcomes. The longer recovery observed with extended (20-session) HBOT courses likely reflects greater baseline disease severity rather than a reduced treatment effect. Given the retrospective design and clinical heterogeneity, further studies are needed to clarify patient selection criteria and define optimal HBOT protocols in oculoplastic reconstruction.