The Center for Wound Healing & Hyperbaric Medicine and Soft-tissue Radionecrosis (STRN)

April 2026

Soft-tissue radionecrosis (STRN) remains one of the most challenging delayed complications of radiation therapy. Months to years after successful oncologic treatment, patients may experience the effects of radiation treatment. These symptoms can include delayed wound healing at surgical sites, pain, and tissue breakdown. In cases where pelvic and rectal tissues are irradiated, bleeding, increased urgency, incontinence, and fistula formation can occur.

Chronic radiation-related soft tissue injury may also manifest as telangiectasia, mucosal friability, strictures, necrosis, or recurrent infections. These injuries can be refractory to traditional approaches due to the complex pathophysiology of radiation.

Hyperbaric Oxygen Therapy (HBOT) is a well-established, evidence-supported intervention for delayed radiation injury and is recognized by The Centers for Medicare and Medicaid (CMS), the Undersea & Hyperbaric Medical Society (UHMS) and the National Center for Biotechnology Information (NCBI) as a standard therapeutic indication. For referring physicians, understanding the mechanism, evidence base, and referral criteria is critical to optimizing patient outcomes.

MECHANISM OF ACTION: WHY HBOT WORKS

Hyperbaric Oxygen Therapy involves inhalation of 100% oxygen at pressure two to three times normal atmospheric pressure, typically for 90-110 minutes per session. HBOT exerts therapeutic effects through several mechanisms:

Hyperoxygenation of Hypoxic Tissue: Elevated atmospheric pressure increases plasma-dissolved oxygen, allowing diffusion into ischemic tissue independent of damaged microvasculature.
Angiogenesis Stimulation: Repeated hyperoxia exposures stimulate neovascularization. Capillary budding and improved vascular density help reverse radiation-induced endarteritis.
Fibroblast Proliferation and Collagen Synthesis: Oxygen tension directly enhances fibroblast activity and collagen matrix deposition—essential for durable wound healing.
Immunomodulation and Infection Control: HBOT enhances leukocyte oxidative killing capacity and supports infection management in compromised tissue beds.

PATHOPHYSIOLOGY OF SOFT-TISSUE RADIONECROSIS

Radiation injury is fundamentally a microvascular disease. Ionizing radiation induces:

Obliterative endarteritis
Progressive fibrosis
Reduced capillary density
Chronic tissue hypoxia
Impaired fibroblast function
Diminished collagen synthesis

The result is hypovascular, hypocellular, and hypoxic tissue with severely compromised healing capacity. Minor trauma, surgical intervention, or infection can precipitate tissue breakdown in these compromised fields. Without restoration of oxygen delivery and vascular integrity, healing is often incomplete or unsustainable.

CLINICAL INDICATIONS & REFERRAL CRITERIA

HBOT is indicated for delayed radiation injury in:

Head and neck soft tissue
Mandible or Maxilla (with osteoradionecrosis)
Breast and chest wall
Pelvic and bladder soft tissue
Rectal and peri-rectal soft tissues
Surgical sites acute or chronic within irradiated fields

Consider referral when patients present with:

Non-healing wounds in previously irradiated areas
Persistent ulceration or tissue necrosis
Radiation cystitis or proctitis refractory to medical therapy
Prior to planned surgery in irradiated tissue
Post-surgical wound dehiscence in previously irradiated areas

Early referral often improves outcomes, particularly when HBOT is initiated before extensive tissue breakdown occurs.

FREQUENTLY ASKED PATIENT QUESTIONS (FAQS)

HYPERBARIC OXYGEN THERAPY FOR SOFT-TISSUE RADIONECROSIS

Is Hyperbaric Oxygen Therapy (HBOT) safe?
Yes, HBOT is generally safe, well tolerated and effective when performed by hyperbaric medicine professionals in a medical facility. To ensure your safety and prior to initiating any treatment, our hyperbaric physician and hyperbaric staff will review your medical history, provide you with a comprehensive medical evaluation and education, along with a tour of our chamber facility.

How does Hyperbaric Oxygen Therapy (HBOT) help?
Hyperbaric Oxygen Therapy helps by delivering high levels of oxygen to damaged tissue. During treatment, you breathe 100% oxygen in a pressurized chamber. The increased pressure allows oxygen to dissolve into your bloodstream and reach areas where circulation has been reduced by radiation.

HBOT helps:

Stimulate the growth of new blood vessels
Support collagen production and tissue repair
Improve wound healing
Enhance the body’s ability to fight infection

This therapy addresses the underlying problem—lack of oxygen—rather than just treating symptoms. HBOT is recognized by the Undersea & Hyperbaric Medical Society as an approved treatment for delayed radiation injuries.

What conditions related to radiation can HBOT treat?
HBOT may be recommended for patients with:

Non-healing wounds in a radiated area
Jaw complications after head and neck radiation
Radiation cystitis (bladder irritation)
Radiation proctitis (rectal irritation)
Wound healing problems after surgery in previously radiated tissue

If you are experiencing persistent symptoms in an area that received radiation therapy, it may be worth discussing HBOT with your physician.

What can I expect during treatment?
A typical HBOT course includes:

30-40 treatments
One session per day, five days per week
Each session lasting about 90-110 minutes

What does Hyperbaric Oxygen Therapy (HBOT) feel like?
During treatment, you relax inside a hyperbaric chamber while breathing 100% Oxygen. At the beginning of each treatment we will pressurize the chamber; most patients describe the sensation as similar to the pressure changes felt during airplane travel.

Many patients begin to notice symptomatic improvement after about 20 sessions, with continued progress over the full treatment course.