Mecanismos moleculares y evidencia clinica de la oxigenoterapia hiperbárica en la cicatrización de úlceras de origen vascular: una revisión de la evidencia actual Molecular mechanisms and clinical evidence of hyperbaric oxygen therapy in the healing of vascular ulcers: a review of current evidence

ABSTRACT Tissue repair in patients with vascular pathology represents one of the most complex challenges in regenerative medicine. In conditions such as diabetes mellitus and peripheral arterial disease, as well as chronic venous insufficiency, the wound microenvironment is compromised by critical hypoxia and metabolic dysregulation that halts the healing process in a persistent inflammatory phase. Hyperbaric oxygen therapy (HBOT) has emerged not only as an oxygen supplement but as a potent genetic and enzymatic modulator capable of reversing this stagnation. To this end, a narrative review was conducted through an advanced search in PubMed/MEDLINE, ScienceDirect, and Google Scholar, selecting 27 high-impact articles (2019-2026). Priority was given to meta-analyses, systematic reviews, and clinical trials to describe how intermittent hyperoxia stabilizes hypoxia-inducible factor 1-alpha (HIF-1α), activates reduction-oxidation (redox) signaling pathways, and modulates the immune response to facilitate the transition toward the proliferative and remodeling phases. Current evidence suggests that, while HBOT is a crucial adjunct in reducing amputation rates in diabetic foot by stabilizing HIF-1α and modulating redox, its success in venous pathology is closely linked to the prior resolution of underlying venous hypertension.