co2 in surgery

The Role of Carbon Dioxide Therapy

in the Treatment of Chronic Wounds.

CESARE BRANDI et al.

Plastic Surgery Unit, Department of General and Specialist Surgery,

Siena University, S. Maria alle Scotte Universitary Hospital, 53100 Siena, Italy

in vivo 24: 223-226 (2010)

"Considering the safety, efficacy and reliability of this method, even if further studies are necessary, we believe that it is useful to include subcutaneous carbon dioxide therapy in the treatment of wounds involving hypoxia-related damage"

Transdermal CO2 Application in Chronic Wounds

U. Wollina, MD, Birgit Heinig, Dipl-Med, Christine Uhlemann, MD

"Transdermal CO2 application is a useful method to reduce the risk of infection and improve wound healing in both chronic and certain acute wounds."

A Novel System for Transcutaneous Application of

Carbon Dioxide Causing an ‘‘Artificial Bohr Effect’’ in the Human Body

Yoshitada Sakai et al

Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

"CO2 therapy has a clinical effect in the treatment of ischemic legs and Raynoud’s phenomenon. The effect is caused by the improvement of microcirculation, increasing in tcPO2, and causing the Bohr effect, which we report here"

Transcutaneous CO2 application accelerates fracture repair in streptozotocin-induced type I diabetic rats.

Takahiro Oda et al

BMJ (British Medical Journal) 2020

"Transcutaneous application of CO2 accelerates fracture repair in a rat fracture model by promoting angiogenesis, blood flow, and endochondral ossification at the fracture site."

"Reverses the inhibition of cartilage formation, endochondral ossification, bone formation, and mechanical properties that are reported to cause delayed fracture repair in DM."

"Several authors have already reported the effects of application of CO2

on healing of wounds and ulcers."

Carbon dioxide inhibits UVB‑induced inflammatory response by activating

the proton‑sensing receptor, GPR65, in human keratinocytes

Keimon Sayama et al

Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo,

Japan.

"the effect of CO2 on UVB-induced

erythema was confirmed. CO2 suppressed the UVB-induced production of tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6) in keratinocytes and the 3D epidermis."

"Hence, CO2 suppresses skin inflammation and can be employed as a potential therapeutic agent in restoring skin immune homeostasis."

Carbon Dioxide–Rich Water Bathing Enhances Collateral Blood Flow in Ischemic Hindlimb via Mobilization of Endothelial Progenitor Cells and Activation of NO-cGMP System

Hidekazu Irie et al

Circulation. 2005;111:1523-1529

"A greater degree of blood perfusion recovery was observed in the ischemic limbs of CO2-bathed mice compared with controls (38% increase at day 28, P<0.001)"

"Our present study demonstrates that CO2 bathing of ischemic hindlimb causes the induction of local VEGF synthesis, resulting in an NO-dependent neocapillary formation associated with mobilization of endothelial progenitor cells."

Clinical and microcirculatory effects of transcutaneous CO2 therapy in intermittent claudication. Randomized double-blind clinical trial with a parallel design

R Fabry et al

"The Strandness test showed a significant increase in total distance walked (+ 131 meters, 66%; p = 0.001) and pain-free distance (+ 81 meters, 73%; p = 0.02) after 18 days of CO2 treatment"

Effect of artificial carbon dioxide foot bathing on critical limb ischemia (Fontaine IV) in peripheral arterial disease patients

T Toriyama et al

"Twenty-seven of 28 limbs (96.4%) which have ulcer and gangrene in only one toe, 13/16 limbs (81.2%) in multiple toes and 29/39 limbs (74.4%) in all toes and/or heel respectively were saved."

Effect of transcutaneous application of gaseous carbon dioxide on cutaneous microcirculation

Miha Finzgar et al

"Artificially applied carbon dioxide (CO2) has the potential to improve the perfusion and oxygenation of tissues, hence is useful for the healing of chronic wounds."

Effect of Carbon Dioxide Therapy

on Diabetic Foot Ulcer

Naeem Shalan, Abdulrahman Al-Bazzaz, Israa Al-Ani*, Fadi Najem, Mohammad Al-Masri

Faculty of Pharmacy and Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan

Journal of Diabetes Mellitus, 2015, 5, 284-289

"Carbon dioxide therapy is beneficial in improvement of diabetic foot ulceration and it has increased blood flow to the affected foot, improved the sensation, and decreased the necrosis"

Use of Transcutaneous Application of CO2 in Diabetic Foot Pathology

Igor Frangez1*, Jure Colnaric1, Danijela Truden2

1Department of Traumatology, University Medical Centre Ljubljana, Zaloška Cesta, Ljubljana, Slovenia

2Center for Peripheral Vascular Rehabilitation, Koprska Ulica, Slovenia

"increased delivery of CO2 to the ulcerated area will cause vasodilation and an increase in blood flow. The improved angiogenesis and oxygenation will result in healing of the chronic wound."

The effect of transcutaneous application of gaseous CO2 on diabetic chronic wound healing—A double-blind randomized clinical trial

Milos Macura et al

Int Wound J. 2020;17:1607–1614.

"a randomized double-blind clinical study confirmed the effect of transcutaneous application of gaseous CO2 on chronic wound healing in diabetic patients. After 20 CO2 therapies in four weeks, 20 of 30 wounds healed completely, while in the control group receiving 20 placebo therapies with air, none of the 27 wounds healed completely. According to our results, transcutaneous application of gaseous CO2 is an effective adjuvant therapy for treatment of chronic wounds in diabetic patients."

Adrian Garrido Sanchis 1, Richard Pashley 1 and Barry Ninham 2

1 School of Physical, Environmental and Mathematical Sciences, University of New South Wales, Canberra, Northcott Drive, Campbell, Canberra, ACT 2610, Australia and

2 Department of Applied Mathematics, Research School of Physical Sciences, The Australian National University, Canberra, ACT, Australia

Correspondence: Richard Pashley

www.nature.com/npjcleanwater

"The availability of clean water is a major problem facing the world. In particular, the cost and destruction caused by viruses in water remains an unresolved challenge and poses a major limitation on the use of recycled water. Here, we develop an environmentally friendly technology for sterilising water. The technology bubbles heated un-pressurised carbon dioxide or exhaust gases through wastewater in a bubble column, effectively destroying both bacteria and viruses. The process is extremely cost effective, with no concerning by-products, and has already been successfully scaled-up industrially".

The Effect of Gas Permeability of Film Dressings on Wound Environment and Healing.

Larry M. Sirvio, M.S., and Duane M. Grussing

3M Biosciences Research Laboratory. St. Paul. Minnesota. U.S.A.

1989 by The Society for Investigative Dermatology

"We have determined the effect of oxygen and carbon dioxide permeability of thin film dressings on wound exudate P 02. P

CO2 , pH. and epithelialization in shallow wounds on domestic pigs."

"The gas tensions and pH are a

reflection of the ability of the films to control the diffusion of oxygen into and the loss of carbon dioxide from the wound exudate"

"Our results suggest that dressings with high permeability to CO2 (such as silicone) may be inappropriate for wound dressings"

GEORGE W. FRAME, A.B ., WA LTER G. STRAUSS, M.D.  AND HOWARD I. MAIBACH, M.D

From the Letterman Army Institute of Research, Presidio of San Francisco, San Francisco, California and the Department of Dermatology, University of California School of Medicine, San Francisco, California 94122 .

THE JOURNAL OF INVESTIGATIVE DERMATOLOGY. 1972

"more recent experimenters have established carbon dioxide losses from the skin as high as 2.7 per cent of the total respiration"

Takashi Ito, MD.,Ph.D., Joanne I.Moore, Ph.D., and Michael C.Koss, Ph.D.

Department of Pharmocology, University of Oklahoma, Oklahoma, USA.

The Society of Investigative Dermatology, Inc

"The topical application of carbon dioxide water to the rat hindpaw produced a concentration-dependent increase of skin blood flow as measured by laser Doppler flowmeter. About a 100% increase of skin blood flow occurred in response to CO2 when the bath temperature was at 23 degrees C or 34 degrees C, but there was no significant effect of CO2 at 41 degrees C. 

Carbon dioxide exposure also produced about the same increase of skin blood flow in the acutely or chronically denervated paw as in the control. These findings give experimental support for the clinical use of CO2 bathing in the treatment of disturbances of skin circulation as well as skin ulcers and wounds." 

Topical cutaneous application of CO2 accelerates bone healing in a rat femoral

defect model.

Yu Karoiwa et al

BMC Musculoskeletal Disorders (2019) 20:237

"Radiographically, bone healing rate was significantly higher in the CO2 group than in the control group at 4 weeks (18.2% vs. 72.7%). The degree of bone healing scored using the histopathological Allen grading system was significantly higher in the CO2 group than in the control group at 2 weeks (1.389 ± 0.334 vs. 1.944 ± 0.375). The ultimate stress, extrinsic stiffness, and failure energy were significantly greater in the CO2 group than in the control group at 4 weeks (3.2 ± 0.8% vs. 38.1 ± 4.8%, 0.6 ± 0.3% vs. 41.5 ± 12.2%, 2.6 ± 0.8% vs. 24.7 ± 5.9%, respectively.). The volumetric bone mineral density of the callus in micro-computed tomography analysis was significantly higher in the CO2 group than in the control group at 4 weeks (180.9 ± 43.0 mg/cm3 vs. 247.9 ± 49.9 mg/cm3). Gene expression of vascular endothelial growth factor in the CO2 group was significantly greater than that in the control group at 3 weeks (0.617 ± 0.240 vs. 2.213 ± 0.387).

Conclusions: Topical cutaneous application of CO2 accelerated bone healing in a rat femoral defect model. CO2 application can be a novel and useful therapy for accelerating bone healing in bone defects; further research on its efficacy in humans is warranted."

Topical cutaneous application of carbon dioxide via a hydrogel for improved fracture repair: results of phase I clinical safety trial.

Takahiro Niikura et al

BMC Musculoskeletal Disorders (2019) 20:563

"In addition to the effect of accelerating fracture healing, various positive effects of CO2 therapy have been reported in pre-clinical studies. One example is the effects of CO2 therapy on muscles, which include muscle fiber switching in skeletal muscle [27], acceleration of muscle injury repair [28], and acceleration of the performance of endurance exercise [29]. Another example relates to the effects of this therapy on tumors. CO2 therapy has been demonstrated to have inherent antitumor effects [30–33] by suppressing metastasis [33, 34], enhancing the antitumor effect of radiation therapy [35, 36], and suppressing bone destruction caused by bone metastasis [37]. All of these are targets that warrant further examination in clinical trials. The clinical trial reported herein is the first such trial involving human patients, and therefore, the information we provide regarding the proven safety of CO2 therapy will be valuable to other investigators conducting future clinical trials for various diseases."

"we believe that CO2 therapy is a promising new clinically applicable tool that can be used to assist fracture repair."