Healing After Mohs & Radiation: How Hyperbaric Oxygen Therapy Boosts Wound Recovery

Explore how Undersea and Hyperbaric Medicine (HBOT) significantly improves wound healing for patients experiencing complications after Mohs surgery and radiation therapy. 

Taking care of your skin is a journey, and sometimes that journey involves procedures like Mohs surgery to treat skin cancer. It's an incredibly effective treatment with high cure rates, often considered the gold standard. However, in some cases, particularly with aggressive or recurrent skin cancers, radiation therapy might be recommended as an additional step after Mohs surgery.

While both Mohs and radiation are powerful tools against cancer, the combination, especially the effects of radiation, can sometimes lead to challenges in the healing process. If you've navigated Mohs surgery followed by radiation, you might be facing a wound that's taking its time to heal, or perhaps experiencing other skin issues in the treated area. This can be discouraging, but please know there are advanced care options available.

Today, we're diving into a remarkable medical therapy that can significantly help promote wound healing in these complex situations: Undersea and Hyperbaric Medicine, specifically Hyperbaric Oxygen Therapy (HBOT). It sounds like something out of a science fiction movie, but it's a well-established, FDA-approved treatment that uses the power of oxygen to support your body's natural repair mechanisms, especially when radiation has made healing tougher.

Let's explore how HBOT works and why it might be the right choice for supporting wound care after Mohs surgery and radiation therapy.

A Quick Refresh: What is Mohs Surgery?

Before we explore the solutions for healing challenges, let's briefly revisit Mohs micrographic surgery. Developed by Dr. Frederic Mohs, this precise surgical technique involves removing skin cancer layer by thin layer. After each layer is removed, it's immediately examined under a microscope in an on-site lab. The surgeon acts as both surgeon and pathologist, meticulously checking the edges (margins) of the tissue. If any cancer cells remain, the surgeon knows exactly where to remove a bit more tissue, repeating the process until all cancer is gone.

Key benefits of Mohs surgery include:

• Highest Cure Rates: Especially for common skin cancers like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
• Tissue Preservation: By removing only cancerous tissue, it spares the maximum amount of healthy skin, which is crucial in areas like the face, neck, hands, and lower limbs.
• Same-Day Results: Usually, the entire procedure, including microscopic analysis and sometimes reconstruction, is completed in a single visit.

Why Might Radiation Therapy Be Used After Mohs Surgery?

While Mohs surgery itself is highly effective, sometimes your dermatologist or oncologist might recommend radiation therapy afterward. This is known as adjuvant therapy. Reasons for this can include:

• Aggressive Tumor Features: Some skin cancers have characteristics under the microscope (histology) that suggest a higher risk of coming back (recurrence), such as deep invasion or perineural invasion (cancer cells tracking along nerves).
• Large Tumor Size or Difficult Location: Cancers that are very large or located in areas where achieving wide clear margins with surgery alone is challenging might benefit from radiation.
• Positive Margins: In rare cases where achieving completely clear margins with Mohs is difficult or impossible without significant functional or cosmetic compromise.
• Recurrent Cancers: If the skin cancer being treated is one that has already returned after previous treatment.
• Immunosuppression: Patients with weakened immune systems may have a higher risk of recurrence, and radiation might be added to improve outcomes.

Radiation therapy uses high-energy rays to destroy any remaining cancer cells and reduce the chance of the cancer returning. It's a vital tool in cancer management.

The Challenge: How Radiation Affects Skin and Wound Healing

Radiation therapy is excellent at targeting cancer cells, but it can also affect the surrounding healthy tissue. This is often referred to as Late Radiation Tissue Injury (LRTI) or radiation damage, and its effects can sometimes appear months or even years after treatment completion.

Here's how radiation can impact your skin's healing ability:

• Reduced Blood Supply (Hypovascularity): Radiation can damage small blood vessels (capillaries) within the treated area. Fewer healthy vessels mean less oxygen and fewer nutrients reach the tissue, which is essential for healing.
• Fibrosis: Radiation can cause tissue to become stiffer and less flexible due to excess collagen deposition (fibrosis). This can make the skin feel tight or woody.
• Cellular Damage: It can directly damage skin cells, including fibroblasts which are crucial for building new tissue.
• Reduced Stem Cell Activity: The natural repair processes involving stem cells may be hindered in irradiated tissue.
• Increased Inflammation: Sometimes, a chronic low-level inflammation can persist in the tissue after radiation.

What does this mean for wound healing after Mohs surgery in a previously irradiated area?

When Mohs surgery is performed on skin that has received radiation, the healing process can be significantly slower and more complicated. 

The wound may struggle to close, be more prone to breaking down (dehiscence), and have a higher risk of infection due to the compromised blood supply and altered tissue environment. Even years later, the surgical site might remain sensitive, and scarring could be more pronounced. This creates non-healing or chronic wounds that require specialized care.

A Breath of Fresh Air for Healing: Introducing Undersea and Hyperbaric Medicine (HBOT)

This is where Undersea and Hyperbaric Medicine (UHM) comes into the picture. While the name might evoke images of deep-sea divers, a major clinical application of this medical subspecialty is Hyperbaric Oxygen Therapy (HBOT).

So, what exactly is HBOT?

HBOT involves breathing 100% pure oxygen while inside a specially designed chamber where the air pressure is increased significantly, typically 1.5 to 3 times higher than normal atmospheric pressure. Think of it like giving your body a super-boost of oxygen under pressure.

There are two main types of chambers:

1. Monoplace Chamber: Designed for one patient at a time. It often looks like a clear, long tube that the patient lies inside.
2. Multiplace Chamber: A larger room that can accommodate several patients (and sometimes a technician) at once. In these, patients breathe the pure oxygen through masks or hoods.

The therapy has been used since the early 20th century, initially for conditions like decompression sickness ("the bends") in divers and later for carbon monoxide poisoning. Over time, its benefits for wound healing and treating oxygen-starved tissues became clear. Today, it's an FDA-approved treatment for various conditions, including late radiation tissue injury.

The Science of Healing: How HBOT Tackles Radiation-Induced Wound Challenges

How does breathing oxygen under pressure translate to better wound healing, especially when radiation has complicated things? HBOT works through several fascinating mechanisms:

1. Super-Oxygenation: The increased pressure allows your blood plasma to absorb much more oxygen than it normally could – potentially 10 to 14 times the standard amount. This oxygen-rich blood can then reach areas with poor circulation (like irradiated tissue) delivering the vital oxygen needed for cellular repair and energy production.
2. New Blood Vessel Growth (Angiogenesis): This is a key benefit for radiation-induced injury. HBOT acts as a powerful stimulus for the body to create new blood vessels. It does this partly by creating fluctuating oxygen levels (higher during treatment, lower between sessions) which signals the body to grow new capillaries into the oxygen-deprived tissue. More vessels mean better long-term blood flow and healing.
3. Reduced Swelling (Vasoconstriction): While it might seem counterintuitive, the high oxygen levels cause temporary narrowing of blood vessels (vasoconstriction). This helps reduce fluid leakage into the tissues (edema or swelling), which can further improve oxygen delivery by relieving pressure on surrounding structures.
4. Fighting Infection: Oxygen itself is detrimental to certain types of bacteria (anaerobes). HBOT also enhances the ability of your white blood cells (leukocytes) to find and destroy harmful bacteria and strengthens your overall immune response in the wound. It can even boost the effectiveness of certain antibiotics.
5. Stimulating Growth Factors & Stem Cells: HBOT encourages the production of growth factors, like Vascular Endothelial Growth Factor (VEGF), which are critical signals for healing and vessel growth. It also helps mobilize stem cells, which can differentiate into various cell types needed to repair damaged tissue.
6. Collagen Production & Fibroblast Activity: HBOT supports the activity of fibroblasts and the production of collagen, the protein matrix that forms the foundation for new skin and tissue.

Essentially, HBOT helps counteract the specific negative effects of radiation on tissue – the lack of oxygen and poor blood supply – while simultaneously boosting the body's own healing toolkit.

H2: HBOT in Action: Enhancing Recovery for Post-Mohs, Post-Radiation Wounds

Now, let's bring it all together. For a patient dealing with a difficult wound after having both Mohs surgery and radiation therapy, HBOT offers targeted benefits:

• Accelerated Healing: By overcoming the oxygen deficit caused by radiation damage, HBOT can significantly speed up the healing of these otherwise non-healing or chronic wounds.
• Improved Outcomes for Skin Grafts and Flaps: If reconstructive surgery involving a skin graft or flap was needed after Mohs, HBOT can be crucial. These grafts/flaps rely heavily on developing a new blood supply. HBOT supports this process, increasing the chances of graft/flap survival and reducing tissue loss.
• Reduced Infection Risk: The compromised nature of irradiated tissue makes infection a significant concern. HBOT's ability to enhance immune function and directly harm certain bacteria provides an added layer of protection.
• Pain Reduction: Many patients with radiation-induced injuries experience pain. Studies show HBOT can alleviate symptoms like pain and swelling.
• Decreased Need for Further Surgery: By promoting successful healing the first time around, HBOT may help avoid the need for additional corrective surgeries.
• Better Cosmetic Results: While scarring is inevitable after surgery, optimized healing facilitated by HBOT can potentially lead to less prominent or problematic scar tissue formation. Studies show lasting improvements even years later.

It's a way to actively intervene and support the healing process when the body is struggling due to the late effects of radiation.

What's an HBOT Session Like? Your Questions Answered

The idea of being inside a pressurized chamber might sound intimidating, but the experience is typically quite manageable and relaxing for most patients.

Here’s what you can generally expect:

• Preparation: You'll likely change into a 100% cotton gown provided by the facility, as synthetic materials can pose a static electricity risk. No cosmetics, perfumes, hairsprays, or deodorants are usually allowed. You'll discuss any medications you're taking with the medical team.
• Entering the Chamber: If it's a monoplace chamber, you'll lie down on a comfortable table that slides into the clear tube. In a multiplace chamber, you'll walk in and sit or lie down, and will wear a mask or hood to breathe the oxygen.
• Pressurization ("The Dive"): As the chamber pressure increases, you'll feel a fullness in your ears, similar to taking off in an airplane or driving up a mountain. The staff will teach you simple techniques (like yawning, swallowing, or pinching your nose and gently blowing) to clear your ears and equalize the pressure. This part usually lasts only a few minutes.
• Treatment Time: Once at the prescribed pressure, you just relax and breathe normally. Sessions typically last between 90 and 120 minutes. You can often listen to music, watch TV, or simply rest. You can communicate with the technician outside the chamber at any time.
• Depressurization ("Ascent"): At the end of the session, the pressure is slowly returned to normal. You might notice a "popping" sound in your ears again as the pressure equalizes.
• After the Session: You might feel slightly lightheaded or tired immediately afterward, but this usually passes quickly. You can typically resume your normal daily activities right away.

How many treatments are needed?

HBOT isn't a one-time fix. For radiation-induced injuries and complex wound healing, a course of treatment is necessary. This usually involves daily sessions for several weeks. A typical course might range from 30 to 40 sessions, or sometimes more, depending on the specific situation and how the wound responds. Improvement is often noticed gradually, perhaps around the 12th to 15th treatment mark.

Are there side effects?

HBOT is generally very safe when administered by trained professionals. Mild side effects are uncommon but can include:

• Ear discomfort or pressure (usually manageable with equalization techniques)
• Temporary changes in vision (nearsightedness), which typically resolve after the treatment course ends
• Fatigue
• Lightheadedness

More serious side effects like oxygen toxicity (seizures) or lung problems are very rare at the pressures used for wound healing. Claustrophobia can be a concern for some, but the clear chambers and communication with staff help alleviate this. Your HBOT team will thoroughly review potential risks and benefits with you.

Is HBOT the Right Path for You?

HBOT is a powerful therapy, but it's not suitable for everyone or every type of wound. Eligibility for treating late radiation tissue injury is well-established.

Who might be a good candidate for HBOT after Mohs and radiation?

• Patients with non-healing surgical wounds in an area previously treated with radiation.
• Patients experiencing complications with skin grafts or flaps in an irradiated field.
• Patients with confirmed radiation damage causing significant symptoms like chronic pain, swelling, or tissue breakdown.
• Patients developing osteoradionecrosis (ORN) – bone death caused by radiation – if the jaw or other bones were in the treatment field.

The decision to pursue HBOT is made after a careful evaluation and consultation with a specialized medical team, which may include your dermatologist, radiation oncologist, surgical oncologist, and a physician board-certified in Undersea and Hyperbaric Medicine or Wound Care. They will assess your specific wound, overall health, medical history, and determine if HBOT is the most effective choice for you. Insurance coverage is generally available for FDA-approved indications like late radiation injury.

Taking the Next Step Towards Enhanced Healing

Facing wound healing challenges after successfully treating skin cancer with Mohs surgery and radiation can feel like an unexpected hurdle. But therapies like HBOT demonstrate how medical science continues to find innovative ways to support your body's recovery.

By delivering high concentrations of oxygen under pressure, HBOT directly addresses the damage caused by radiation, promoting the growth of new blood vessels, reducing inflammation, fighting infection, and ultimately helping even stubborn wounds to heal. It offers hope and a tangible solution for improving quality of life for patients facing these specific complications.

If you're struggling with a wound after Mohs surgery and radiation therapy, don't hesitate to discuss Hyperbaric Oxygen Therapy with your doctor. Ask for a referral to a specialized wound care and hyperbaric center for an evaluation. Taking that step could be the key to getting your healing journey firmly back on track.

Stay informed, stay proactive, and here's to your healthy, radiant skin!