When to Choose HBOT vs. Topical Oxygen Therapy for Wounds

Chronic wounds are a growing health concern for many residents in Riverside and Corona, especially those living with diabetes, vascular diseases, or recovering from surgeries. Oxygen-based therapies have become a cornerstone of modern wound care, offering accelerated healing in both hospital and outpatient settings. Among them, Hyperbaric Oxygen Therapy (HBOT) and Topical Oxygen Therapy (TOT) are two frequently discussed but often misunderstood options.

At Mission Surgical, we regularly guide patients through understanding these treatments to ensure the best outcomes. This article explores:

What HBOT and TOT actually involve
Key differences in depth, delivery, and biological impact
When to use one over the other
What science and clinical guidelines suggest
How Riverside and Corona patients can benefit from making the right choice

1. Understanding HBOT and TOT

What is HBOT?

Hyperbaric Oxygen Therapy (HBOT) involves placing the patient in a chamber where they breathe 100% oxygen under increased atmospheric pressure (typically 2–3 ATA). This significantly raises oxygen concentration in the blood and diffuses oxygen deep into tissues. It’s a full-body treatment used in hospitals and specialized wound care centers.

What is TOT?

Topical Oxygen Therapy (TOT) delivers oxygen directly to the wound area at or near atmospheric pressure through a sealed device such as a boot or bag. The patient doesn’t breathe oxygen; instead, it’s applied around the wound bed only. It’s generally more convenient and can be done at home but only affects the surface tissue.

2. Key Differences Between HBOT and TOT

Feature	Hyperbaric Oxygen Therapy (HBOT)	Topical Oxygen Therapy (TOT)
Oxygen Delivery	Systemic (enters bloodstream)	Local (applied externally)
Pressure Used	High (2.0–3.0 ATA)	Near normal (1.0–1.013 ATA)
Tissue Penetration	Deep (up to 3–4 cm or more)	Superficial (1–2 mm)
Biological Effects	Promotes angiogenesis, collagen production, anti-inflammatory response	Aids superficial wound oxygenation
Common Settings	Hospitals or specialized centers	Can be used at home
Treatment Time	90–120 minutes per session	60–90 minutes per session

3. Clinical Effectiveness and Evidence

HBOT

Clinical studies and meta-analyses confirm HBOT’s success in:

Diabetic foot ulcers
Radiation-induced tissue damage
Osteomyelitis (bone infection)
Non-healing post-surgical wounds
Compromised skin flaps or grafts

A large review of randomized trials found HBOT significantly improves healing rates in diabetic foot ulcers and lowers major amputation risk by almost half.

TOT

TOT is primarily used for:

Superficial diabetic ulcers
Mild venous stasis ulcers
Post-surgical wounds that are shallow and non-infected

Research into TOT is ongoing. While some small studies report benefits, especially in outpatient use, the clinical evidence is not as strong or consistent as HBOT.

4. When Should You Choose HBOT?

HBOT is preferred when wounds are:

Deep or involve bone
Associated with poor circulation or ischemia
Complicated by infection (e.g., osteomyelitis)
Involving surgical flaps or grafts that are failing
From radiation injury (head, neck, pelvis, or breast)
Not responding to standard care after several weeks

In Riverside and Corona, where the prevalence of diabetes and vascular diseases is high, HBOT is especially valuable for complex wound cases that need systemic oxygen support.

5. When Might TOT Be a Reasonable Option?

TOT may be appropriate if:

The wound is superficial and not infected
The patient is unable to travel for HBOT sessions
There are no signs of bone or deep tissue involvement
The wound is small and less than 6 weeks old
HBOT is contraindicated (e.g., untreated pneumothorax or severe claustrophobia)

While TOT devices may offer convenience, their effectiveness is limited to surface-level healing. For this reason, TOT is generally recommended only after 4 weeks of standard wound care fails and the wound remains superficial.

6. Considerations: Cost, Insurance, and Safety

Cost & Insurance

HBOT is covered by Medicare, Medi-Cal, and most commercial insurance when medically necessary (e.g., diabetic ulcers, radiation injury, graft compromise).
TOT is less expensive per session but not always covered by insurance, requiring out-of-pocket payments.

Safety

HBOT side effects: mild ear barotrauma, sinus discomfort, temporary vision changes. Rare risks include oxygen toxicity and pneumothorax. At Mission Surgical, thorough evaluations are done to mitigate these risks.
TOT is generally safe but less regulated. Risks include ineffective treatment for deep wounds, which could delay proper care and lead to worsening.

7. Real Patient Cases in Riverside and Corona

Case 1 – HBOT Success:
A 62-year-old man in Riverside with diabetes developed a deep foot ulcer with bone involvement. After 28 sessions of HBOT, the wound fully healed without surgical intervention, avoiding a potential amputation.

Case 2 – TOT Application:
A 55-year-old woman in Corona with a superficial venous ulcer used a TOT device at home after four weeks of standard care. Within six weeks, the wound showed significant improvement, and she avoided in-clinic treatment during the hot summer months.

8. The Clinical Decision-Making Process at Mission Surgical

At Mission Surgical, we use the following criteria to determine the best oxygen therapy option for our patients:

Wound depth and duration
Imaging or biopsy results (if infection is suspected)
Oxygenation testing (e.g., TcPO2)
Overall health and ability to tolerate HBOT
Patient goals and lifestyle (e.g., home care vs. clinic visits)

Each patient receives a customized care plan. We don’t believe in one-size-fits-all. Our focus is always on achieving the best long-term outcome with minimal discomfort or risk.

9. Summary Table – HBOT vs TOT Decision Guide

Clinical Scenario	Recommended Therapy
Deep diabetic foot ulcer	HBOT
Superficial venous ulcer	TOT (if no improvement with basic care)
Post-surgical graft at risk	HBOT
Radiation injury	HBOT
Patient unable to travel	TOT (temporary solution)
Osteomyelitis	HBOT
Wound not healing after 4+ weeks	Evaluate for both

10. Final Thoughts: What’s Right for You?

If you or a loved one in Riverside or Corona has a non-healing wound, understanding the difference between HBOT and TOT is essential for recovery. While both therapies have their place in modern wound care, HBOT remains the gold standard for deep, chronic, and high-risk wounds.

At Mission Surgical, our wound care specialists will help determine which option is best suited for your specific condition, lifestyle, and health needs.

Ready to Get Help?

Contact Mission Surgical in Riverside or Corona to schedule a wound assessment and discuss your treatment options. Don’t wait—early intervention makes a significant difference in healing outcomes.