This review explains how hyperbaric oxygen therapy (HBOT)—breathing high-pressure oxygen—and exosomes—tiny cell-made vesicles carrying proteins and RNA—can work together to speed and improve tissue healing. HBOT raises oxygen levels to reduce hypoxia, promote blood vessel growth, and lower inflammation, while exosomes regulate immune responses, stimulate cell growth, deliver pro-repair signals (like microRNAs), and reduce scarring. HBOT can increase exosome release and change their content (e.g., raising MALAT1) through a “hyperoxia–hypoxia paradox,” and exosomes can protect tissues from HBOT-related oxygen injury. Animal and lab studies show combining the two gives stronger anti-inflammatory, antioxidant, angiogenic, and neuroprotective effects than either alone, helping wounds, nerve injuries, spinal cord and sciatic nerve damage, and ischemic tissue <
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