Background: For most sarcoma patients, limb sparing surgery is the standard of care. However, these salvage procedures may potentially result in complications such as post-operative wound problems owing to the reconstruction processes leading to difficulty in resolving and finding a suitable solution.

Objective: To report the cases and outcome after using a new treatment modality of hyperbaric oxygen therapy [HBO₂T].

Case Report: Four cases show the outcome after using HBO₂T in sequence of limb salvage surgery between December 2008 and December 2015 with evidence-based support. These cases had four different types of predictive major complication, 1) compromised flap with sign of necrosis subsequently attempting coverage after wide resection of the high grade spindle cell sarcoma on the knee, 2) chronic refractory osteomyelitis after wide excision and allograft reconstruction of osteosarcoma of the proximal tibia, 3) soft tissue necrosis subsequent to re-excision of previously irradiated recurrent myxofibrosarcoma, and 4) radiation injury of the cutaneous wound after wide resection and postoperative radiation after refractory wound dehiscence occurring in pleomorphic leiomyosarcoma left lateral ankle.

Results: Compromised flap after treating with HBO₂T application for 20 sessions, recovery of the viable tissues were achieved. Osteomyelitis after allograft reconstruction, infection was subsided then knee fusion was performed afterward. Healing enhancement in resected wound with previously irradiated area. Wound dehiscence was closed in postoperative radiation.

Conclusion: HBO₂T can be considered as an adjuvant therapy for problem cases in salvage resolution in sequence of limb salvage surgery and beneficial to enhance wound healing.

Keywords: Hyperbaric oxygen therapy, Chronic osteomyelitis, Compromised flap, Wound, Radiation injury, Salvage, Allograft infection, Sarcoma