A breath of fresh air: the role of oxygen carriers in plastic surgery

Tissue hypoxia represents a major challenge in regenerative medicine because it may impair wound healing and contribute to tissue necrosis and eventually reconstructive failure. To overcome this problem, topically applied oxygen carriers have emerged as a promising strategy to enhance tissue oxygenation independently of vascular function. This narrative review summarizes the clinical evidence for the use of oxygen carriers in plastic, reconstructive and aesthetic surgery. Four principal categories were identified, including hemoglobin-, peroxide-, and microalgae-based oxygen carriers as well as physical oxygen carriers. Hemoglobin- and peroxide-based oxygen carriers have shown beneficial effects on wound healing. However, evidence from randomized controlled trials remains inconsistent and large-scale studies for other indications are limited. In an early clinical study, microalgae-seeded scaffolds enabled controlled in situ oxygen production and provided structural support for full-thickness skin defects. Physical oxygen carriers have demonstrated positive preliminary results in promoting re-epithelialization of donor sites of split-thickness skin grafts but otherwise remain insufficiently investigated. Taken together, oxygen carriers represent a biologically plausible strategy to prevent tissue hypoxia. Although current clinical evidence suggests potential benefits, the literature on oxygen carriers remains limited by small patient cohorts, heterogeneous methodologies, and retrospective study designs. Therefore, future research should prioritize randomized controlled trials with standardized outcome measures and direct comparisons with established treatment modalities.