- OHIP-direct billing for covered indications
- Same- or next-day urgent consults
Specialty Referral Guide
HBOT Referrals from
Plastic Surgery
Partner in Care
Plastic surgery is one of our closest specialty partnerships. HBOT can be a useful adjunct for compromised grafts and flaps, complex chronic wounds, and reconstructive surgery in previously irradiated fields.
Referral Guide
When to Refer & What to Include
Conditions to consider for HBOT referral
- Compromised skin grafts and flaps — urgent referral
- Chronic non-healing wounds awaiting or following reconstruction
- Pre- and post-operative HBOT for surgery in previously irradiated fields (e.g., breast reconstruction post-radiation)
- Selected post-surgical complications in high-risk patients
The Evidence
Evidence Highlights
- For compromised grafts and flaps, animal and clinical evidence support improved survival when HBOT is initiated early after signs of compromise. Time matters.
- For surgery in irradiated fields, the Marx protocol (20–30 pre-op + 10 post-op sessions) is a well-established framework supported by Cochrane evidence.
Timing & urgency
Compromised graft or flap: call directly for same-day or next-day scheduling.
Pre-operative HBOT in irradiated fields: please refer 6–8 weeks before the planned procedure to allow time for the 20–30 pre-op sessions.
Special Focus
Special focus — filler-induced
vascular occlusion
Vascular occlusion is a recognized and time-critical complication of cosmetic dermal filler injection. When filler material is injected intravascularly or compresses an artery, the result is local ischemia of the dependent tissue. If not reversed promptly, this can progress to skin necrosis, scarring, and — in the case of involvement of the ophthalmic arterial supply — vision loss.
Initial management is led by the injecting practitioner and follows the established protocol of immediate cessation of injection, hyaluronidase (for hyaluronic-acid fillers), warm compresses, massage, nitroglycerin paste, and analgesia. Hyperbaric oxygen therapy is a recognized adjunct for cases that do not resolve with initial management, or that present with established or evolving necrosis. The rationale is the same as for other forms of acute tissue ischemia: HBOT delivers oxygen to tissue beyond the level of vascular compromise, supports the survival of marginally perfused tissue at the watershed, and limits the size of the eventual demarcated necrotic area.
OHIP coverage
Filler-induced vascular occlusion is an OHIP-covered indication for HBOT at Evolve. The patient’s funding status is not a barrier to urgent referral — call us first; billing follows. Eligible Ontario patients with a valid health card pay $0 out-of-pocket. We confirm coverage at the time of consultation, but in this clinical scenario the decision to refer should never wait on a coverage question.
When to call us
Time is tissue. If you have a patient with suspected filler-induced vascular occlusion that has not fully resolved after initial standard management, please call our network referral line directly: 1-888-851-4268. Cases of suspected or evolving necrosis are triaged same-day and, where appropriate, started on HBOT within 24 hours of presentation.
Typical protocol
- Pressure: 2.4 ATA
- Duration: 90 minutes at depth
- Block 1 (intensive phase): twice daily (BID) for 5 days (≈10 sessions)
- Reassessment: clinical review of tissue response, pain, perfusion, and demarcation
- Block 2 (consolidation phase): a further ~5 days at 2.4 ATA, frequency adjusted to clinical response
- Course: typically around 20 sessions, guided by tissue recovery
- Concurrent care: continued standard management led by the injecting practitioner — hyaluronidase, vasodilator therapy, wound care — runs throughout the HBOT course
Note on vision threat
Suspected or actual filler-induced ophthalmic artery occlusion is a true ophthalmologic emergency. These patients should be sent directly to the nearest emergency department or ophthalmology service for immediate evaluation, not to an outpatient hyperbaric clinic. We are available by phone (1-888-851-4268) for any coordination after acute ophthalmologic management.
Medical review
Dr. Vik Agarwal MD CCFP FRCPC CAQ-HP — President, Evolve Medical Group
Dr. Seema Agarwal MD CCFP CAQ-HP — Chief Medical Officer, Evolve Hyperbarics
Last reviewed: May 2026 · Next: May 2027
Refer a Patient
Ready to Refer or Discuss a Case?
Send a referral through whatever channel suits your workflow, or call 1-888-851-4268 to
discuss a case directly with the on-call hyperbaric physician.