The role of hyperbaric oxygen therapy in the treatment of sternal wound infection.

Sternal wound dehiscence and infection are major problems for patients and health care providers. A range of risk factors, including diabetes, obesity and internal thoracic artery harvest, has been implicated. Several pathophysiological mechanisms, which may account for the development of infection, have been proposed. There is a growing body of evidence which suggests that sternal ischaemia may play a significant role in the initiation of wound infection, and that this may be exacerbated by harvest of the internal thoracic artery. Current treatments for infection include wound debridement, irrigation and tissue flap reconstruction. In addition, several novel therapies such as negative pressure dressings have been shown to be safe and useful. Hyperbaric oxygen therapy - the administration of 100% oxygen at pressures greater than atmospheric pressure - is widely used in the treatment of various chronic wounds. The mechanism whereby hyperbaric oxygen exerts its effects is being elucidated and there is a growing body of clinical evidence that supports its use. It has been suggested that there may be a role for hyperbaric oxygen therapy in the treatment of sternal infection. The theoretical mechanisms would seem plausible, but at present there is only limited evidence to support its use. This review addresses the theory and evidence supporting the role of hyperbaric oxygen therapy in the treatment of sternal wound infection.