Surgical wound complications
Surgical wound complications are problems with healing after an operation, such as infection, the wound edges separating (dehiscence), or slow healing. The surgical team manages them, with antibiotics, wound care and sometimes further surgery. Evidence on hyperbaric oxygen therapy (HBOT) for these wounds is developing. Research is ongoing and HBOT is not currently positioned as a standard treatment for this condition.
This page is written for adults whose wound is not healing as expected after an operation, their families, and the surgical teams looking after them.
What surgical wound complications are
Every surgical wound carries some risk of complications. NHS guidance lists them as including wound dehiscence, a collection of fluid (seroma) or blood (haematoma), delayed healing, abnormal scarring, incisional hernia and surgical site infection.
NICE describes a surgical site infection as a surgical wound with local signs of infection, such as heat, redness, pain and swelling, and in more serious cases fever. Infection may stop the wound healing and cause its edges to separate, or form an abscess in the deeper tissues.
A wound that is not healing after surgery should not automatically be put down to slow healing. Your surgical team may need to assess for infection, including deeper infection, a collection of blood or fluid, a problem with the repair, reduced blood supply, and other treatable causes.
Two related situations have their own pages: a skin graft or flap that is not surviving as expected, and wounds in tissue previously treated with radiotherapy. A rapidly spreading soft tissue infection after surgery needs immediate surgical treatment.
How surgical wound complications are normally treated
Your surgical team leads this, and the treatment depends on the cause.
- Infection. NICE says that when a surgical site infection is suspected, the patient should be given an antibiotic that covers the likely organisms, taking account of local resistance and microbiology results. A deeper collection may need draining.
- Wounds healing by secondary intention, which means from the base upwards rather than closed. NICE recommends an appropriate dressing, and advice from a tissue viability nurse or another professional with tissue viability expertise.
- A wound that has opened, or a collection of blood or fluid. The surgical team decides whether it needs further surgery, drainage or wound care.
- A structured approach to wound care, which NICE says should include identifying people at risk of wound healing problems before surgery.
Standard care comes first. HBOT never replaces antibiotics, drainage, debridement, further surgery, wound care or other treatment your surgical team recommends.
What UK guidance says
We have not identified a NICE recommendation on HBOT for surgical wound complications. NICE's guideline on surgical site infections (NG125) covers their prevention and treatment and does not address HBOT. The absence of a recommendation is not proof of benefit or proof of no benefit.
NHS England's national specialised HBOT service is provided for two indications, decompression illness and gas embolism. Surgical wound complications are not among the indications it provides for, and they are not named in its list of indications that are not routinely commissioned either. Necrotising soft tissue infection, which can follow surgery, is listed as not routinely commissioned for adults.
That is the current UK framework and Heal & Go₂ works within it.
What international guidance says
We have not identified international guidance that recommends HBOT for surgical wound complications as a group. The European and American hyperbaric bodies address some specific situations separately.
The European Committee for Hyperbaric Medicine suggests HBOT for a compromised skin graft or flap (type 2, level C), covered on our grafts and flaps page. It recommends HBOT for necrotising soft tissue infections (type 1, level C) only as part of a protocol with immediate and adequate surgery and antibiotics. It gives no recommendation for deep infection after surgery through the breastbone (post-sternotomy mediastinitis), because the evidence is very low (grade D).
The Undersea and Hyperbaric Medical Society recognises compromised grafts and flaps and necrotising soft tissue infections among its accepted indications, and says HBOT is neither necessary nor recommended for normal, uncompromised grafts or flaps.
These professional recommendations do not establish benefit for an individual patient, and they do not change UK guidance or commissioning.
Where it is used routinely
We have not identified a health system that funds HBOT routinely for surgical wound complications as a group. In the United States, Medicare's coverage is limited to named indications, such as compromised skin grafts, rather than surgical wounds in general.
Where the evidence shows possible benefit
Evidence is developing. A 2013 Cochrane review of HBOT for acute surgical and traumatic wounds included four small trials with 229 people. Two of them, one on skin grafts after burns and one on crush injuries, reported results in favour of HBOT, but both were at risk of bias.
For surgery in tissue previously treated with radiotherapy, a 2023 Cochrane review reported that HBOT may reduce wound dehiscence after head and neck soft tissue surgery, based on two randomised trials with 264 people and rated low-certainty evidence. That finding is limited to irradiated head and neck tissue and does not extend to surgical wounds in general.
Where the evidence does not support use
The 2013 Cochrane review found a lack of high quality evidence on HBOT for wound healing after surgery or injury. All four of its trials were at unclear or high risk of bias, and none tested HBOT for surgical site infection or for a wound that had opened.
For deep infection after surgery through the breastbone, a 2026 scoping review found the evidence sparse and varied. In every report HBOT was given alongside surgery and antibiotics, so the studies cannot separate its effect from that of the other treatment, and the authors said HBOT should not delay definitive surgical care. We have not identified a systematic review of HBOT for wound complications after orthopaedic surgery.
Research is ongoing and HBOT is not currently positioned as a standard treatment for this condition. We cannot infer a reliable benefit for an individual patient from small or biased studies.
Where the evidence is weak or absent we say so here rather than leaving it out.
How we assess whether treatment is appropriate
HBOT is not offered for surgical wound complications in general, and a wound that is healing as expected does not need it. Where the evidence is weakest, it would only very rarely be considered and never as a first step.
Standard care comes first. Your surgical team stays in charge. Nothing on this page is a reason to change, pause or delay anything they have recommended, including antibiotics, drainage or further surgery. If HBOT is considered, we work alongside them and share our assessment and treatment plan.
HBOT has risks and contraindications, including pressure-related ear injury and temporary visual changes, and recent surgery needs particular assessment. We review relevant medicines, medical conditions and chamber safety before making a recommendation. Our safety page provides more detail; an individual clinical assessment determines whether treatment is suitable.
How the assessment works. We normally require a referral and relevant information from the surgical team, including the operation and its date, the current state of the wound, microbiology and imaging, and what has been done so far. Our assessment must never delay urgent surgical care. The Medical Director reviews the diagnosis, the cause of the problem, treatment so far, evidence and safety within our clinical governance process, then explains whether HBOT has any plausible adjunctive role. We discuss uncertainties, risks, alternatives and costs before any decision. An assessment is not a promise of treatment or benefit. If we do not think HBOT is appropriate, we will say so.
Common questions
My wound has opened up after surgery. What should I do first?
Contact the surgical team that did your operation, the same day. A wound that opens, discharges, smells or becomes red, hot and swollen needs assessing for infection or a collection underneath. Those need the surgical team, not us. Call 999 if you are severely unwell or bleeding heavily.
Is hyperbaric oxygen available on the NHS for a surgical wound?
NHS England's national HBOT service is provided for decompression illness and gas embolism. Surgical wound complications are not among the indications it provides for. NICE's guideline on surgical site infections does not address HBOT. Ask your surgical team whether any research study applies to you.
Does HBOT help surgical wounds heal?
Evidence is developing. A 2013 Cochrane review found a lack of high quality evidence for wounds after surgery or injury, and its trials were small and at risk of bias. A 2023 review found HBOT may reduce wounds reopening after head and neck surgery in irradiated tissue, on low-certainty evidence. That does not apply to surgical wounds in general.
Is it safe after an operation?
It is generally well tolerated but not without risk, including ear pressure injury and temporary visual changes. Recent surgery needs particular assessment, which is another reason we speak to your surgical team first. See our safety page for more detail.
- Clinical and advertising approval
- Approved 14 October 2026 · Dr Anil Dasineni
- Reviewed by
- Dr Anil Dasineni, MBBS, DNB (Emergency Medicine), MRCEM. Registered with the General Medical Council with a licence to practise.
- Last reviewed
- 14 October 2026
- Next review due
- 14 October 2027
- Clinical tier
- Tier 2
Sources (12)
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