Recherche clinique sur le pied et la cheville

Abstrait

Use of Transcutaneous Application of CO2 in Diabetic Foot Pathology

Igor Frangez, Jure Colnaric, Danijela Truden

In neuropathic foot ulcers, the most prominent finding is the loss of peripheral sensation and is typically seen in diabetic patients. In addition, vasculopathy may lead to foot ulcerations in diabetic patients. CO₂ therapy was found to improve chronic wound healing in patients with vascular impairment. It refers to the transcutaneous and subcutaneous application of CO₂ as well as CO₂ water baths for therapeutic purpose. In the method used, gaseous CO₂ is applied transcutaneously using the PVR system^®. CO₂ is applied by means of a single-use, low-density polyethylene bag which is wrapped around the leg being treated and secured with an elastic strap. The advantages of this method, compared to injecting CO₂ into subcutaneous tissue, are non-invasiveness, the absence of pain and protection against infection. Compared to CO₂ balneotherapy this approach enables the use of higher CO₂ concentrations, application to chronic wound patients and, with appropriate precautionary measures, prevents the increase of CO₂ in the surrounding air. Finzgar et al. observed that the transcutaneous application of gaseous CO₂ caused a significant increase in the Laser Doppler (LD) flux in cutaneous microcirculation in vivo in humans. The favourable clinical and microcirculatory effects of gaseous CO₂ have further been observed in studies of patients with intermittent claudication as well as patients with primary and secondary Raynaud's phenomenon. The reviewed studies suggest that the 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. This principle may be applied in the treatment of diabetic foot ulceration. Moreover, the effect on blood flow may also be important in preventive and curative treatment of patients with impaired mobility due to organic or functional causes. Further work is needed for the development of therapeutic strategies to optimize CO₂ use in diabetic foot patients.