English
Carbon dioxide therapy for horses, also known as transcutaneous carbon dioxide (COâ‚‚) therapy, is a non-invasive treatment being investigated as an adjunct to conventional veterinary wound management.
The treatment involves exposing the wound and surrounding tissues to medical-grade carbon dioxide gas. This is intended to increase local blood flow and oxygen delivery, which may create conditions that support tissue repair and wound healing.
Carbon dioxide therapy is being studied for use in wounds on a horse’s lower limbs, where limited circulation, repeated movement, and proud flesh can interfere with healing.
The therapy is not intended to replace standard wound care. Appropriate cleaning, bandaging, infection control, and other treatments recommended by a veterinarian remain important components of wound management.
Keep reading to learn how carbon dioxide therapy is performed, the proposed mechanisms of action, current evidence in horses, and its potential benefits and limitations in equine wound care.
What Is Carbon Dioxide Wound Therapy for Horses?
Transcutaneous carbon dioxide (COâ‚‚) therapy is a non-invasive treatment that exposes injured tissue to medical-grade carbon dioxide gas in an effort to improve local conditions for healing.
Unlike surgical treatments that physically remove damaged tissue or medications that act directly on infection or inflammation, carbon dioxide therapy is intended to stimulate physiological responses involved in blood flow and oxygen delivery. [1][2][3][4]
The treatment is performed by enclosing the affected limb or body region in a sealed plastic chamber or specialized treatment bag. After the chamber is secured, medical-grade humidified carbon dioxide is introduced, allowing the gas to diffuse through the skin and into underlying tissues.
Experimental studies in horses have typically used treatment sessions lasting approximately 30 minutes, repeated several times per week. [2][4][5]
Although carbon dioxide is a waste product of cellular metabolism and respiration, it also has important physiological effects. Small increases in carbon dioxide concentration can dilate local blood vessels and promote the release of oxygen from hemoglobin into surrounding tissues, potentially increasing oxygen availability in the wound area. [6]
Interest in carbon dioxide therapy has grown in both human and veterinary medicine because reduced blood supply and inadequate tissue oxygenation can contribute to delayed wound healing. Researchers have investigated transcutaneous carbon dioxide therapy for chronic wounds, diabetic ulcers, burns, skin grafts, and other difficult-to-heal injuries in people. [3]
Equine studies have focused primarily on distal-limb wounds and, more recently, hoof growth. Although the proposed physiological effects are reasonably well understood, further research is needed to determine the clinical effectiveness of carbon dioxide therapy in horses. [3]
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What's your top priority with your horse's health?
Challenges Affecting Wound Healing in Horses
Most skin wounds in horses heal well with appropriate veterinary wound care. However, wounds on the lower limbs are more difficult to heal and may take weeks or months, with a higher risk of complications.
This slower healing has prompted ongoing research into therapies that may improve tissue repair and reduce recovery times in horses. [1][2]
One of the greatest challenges is the anatomy of the horse’s distal limb, meaning the lower leg below the knee or hock. This area contains very little muscle or soft tissue, providing less cushioning around injuries and a more limited blood supply.
Instead, the skin lies close to tendons, ligaments, joints, and bone, with little soft tissue separating them from the surface. As a result, wounds that appear relatively small can extend into or expose these deeper structures, making them more serious and more difficult to treat.
Limited circulation to these tissues can also reduce the delivery of oxygen, nutrients, and immune cells needed for healing, resulting in slower recovery. [1][2]
Movement can also slow healing. Because horses spend much of the day standing and walking, wounds over joints and tendons are repeatedly stretched with each step. This can disrupt new tissue formation, slow wound closure, and increase the risk of reopening and ongoing inflammation. [1][7][8]
Wound Healing Complications
Wound contamination is a common complication in horses. Injuries are frequently exposed to dirt, bedding, manure, and moisture, which increases the risk of bacterial infection.
Although appropriate cleaning and bandaging can reduce this risk, contamination may prolong inflammation and delay tissue repair. [1][7]
Distal-limb wounds are also prone to developing exuberant granulation tissue, commonly called proud flesh. Granulation tissue is a normal part of wound healing and provides a framework for new blood vessels and connective tissue to develop. [1][8]
In horses, persistent inflammation, repeated trauma, and reduced wound contraction can cause granulation tissue to extend above the level of the surrounding skin. Excessive granulation tissue prevents new skin from growing across the wound, which can delay closure and require additional veterinary treatment. [1][8]
Researchers continue to investigate why distal-limb wounds in horses are particularly susceptible to delayed healing and proud flesh. One proposed factor is local tissue hypoxia, meaning that injured tissues receive insufficient oxygen to support normal repair.
Because transcutaneous carbon dioxide therapy is intended to increase local blood flow and oxygen delivery, it is being studied as a potential adjunctive treatment for these wounds. [3]
Potential Benefits of Transcutaneous Carbon Dioxide Therapy
Carbon dioxide therapy in horses is intended to improve local conditions that support wound healing. It is not a substitute for wound cleaning, bandaging, infection control, or veterinary intervention.
CO2 therapy is based on the idea that increasing carbon dioxide exposure in local tissues can influence blood flow and oxygen delivery. Small increases in carbon dioxide concentration can encourage blood vessels to dilate and promote oxygen release from hemoglobin into surrounding tissues. [2][4][6]
These effects may be useful in wounds where poor circulation, tissue hypoxia, persistent inflammation, or delayed repair contribute to slow healing.
In theory, improved tissue oxygenation and perfusion may support several processes involved in wound repair, including collagen production, angiogenesis, fibroblast activity, epithelialization (development of new skin), and normal immune-cell function. [1][2][3][4]
Potential benefits proposed for carbon dioxide wound therapy include: [2][4][6]
- Improved tissue oxygenation: Increased oxygen release into injured tissues may help create conditions that favor repair.
- Enhanced blood flow: Local vasodilation may improve delivery of nutrients, immune cells, and growth factors while helping remove metabolic waste products.
- Support for tissue repair: Improved perfusion and oxygen availability may support angiogenesis, collagen deposition, fibroblast activity, and epithelialization.
These benefits may have particular relevance for distal-limb wounds, where better circulation may help promote healing in areas where blood supply is naturally limited.
Scientific Evidence
Current evidence in horses is limited but suggests that transcutaneous carbon dioxide therapy may influence early wound behavior.
In one experimental study, larger distal-limb wounds treated with carbon dioxide therapy expanded less during the early stages of healing than untreated control wounds. [3] Limiting early wound expansion may reduce the amount of tissue that ultimately requires repair.
However, the same study did not find significant improvements in granulation tissue formation, histological healing scores, or skin graft acceptance. [3] This means the treatment showed some measurable effects, but did not clearly improve all major markers of wound healing in that study.
Researchers are also investigating whether transcutaneous carbon dioxide therapy has applications beyond wound healing. One study reported increased hoof growth in horses receiving repeated transdermal carbon dioxide treatments. [5]
Although hoof growth involves different biological processes than skin wound healing, these findings suggest that the therapy may influence tissue regeneration more broadly and warrant further study.
Overall, carbon dioxide therapy has a plausible biological rationale and early experimental support, but larger clinical studies are needed to determine which wounds are most likely to benefit, how much improvement owners can expect, and how the treatment should be used within a complete veterinary wound-management plan.
Carbon Dioxide Therapy Treatment Procedures
Carbon dioxide therapy should be performed under the guidance of a veterinarian or trained veterinary professional. Although the treatment itself is non-invasive, specialized equipment is required. [2][3]
Before treatment, the wound is typically assessed to determine its stage of healing and identify underlying problems, such as infection, involvement of deeper structures, or foreign material.
Appropriate cleaning, debridement, bandaging, and any necessary medical treatments are performed according to standard veterinary principles before carbon dioxide therapy is considered. [1][7][8]
The affected area is then enclosed in a sealed treatment bag or chamber, and humidified medical-grade carbon dioxide is introduced. Treatment sessions typically last approximately 30 minutes and are repeated several times per week over a period of several weeks. [3][5]
Carbon dioxide therapy is intended to complement conventional wound care for horses, not replace it. Regular veterinary reassessment remains important to confirm that healing is progressing as expected and to adjust the treatment plan when necessary. [1][3][7][8]
Until more evidence is available, transcutaneous carbon dioxide therapy should be considered an investigational adjunct to established veterinary wound-management practices.
Recovery & Aftercare
Horses receiving carbon dioxide therapy require careful wound management and regular veterinary assessment throughout the healing process. [1][7]
The wound should continue to be managed according to the veterinarian’s recommendations. This may include routine bandage changes, cleaning, restricted exercise, and medications such as antimicrobials or anti-inflammatory drugs when indicated.
Maintaining a clean environment and minimizing contamination are also important throughout recovery. [1][7]
Healing progress should be tracked and assessed over time. Signs of normal healing include gradual wound contraction, healthy pink granulation tissue that remains level with the surrounding skin, reduced drainage, and steady formation of new skin over the wound surface. [1][7][8]
Recovery time varies between horses and depends on factors such as the wound’s size and location, the structures involved, and the horse’s overall health.
Carbon Dioxide vs. Other Wound Therapies
Several adjunctive therapies are available for equine wound management. Each acts through different biological mechanisms, and the amount of available scientific evidence supporting these modalities ranges considerably.
Table 1. Comparison of therapies used in equine wound management
| Therapy | Primary Mechanism | Typical Applications | Evidence in Horses |
|---|---|---|---|
| Conventional wound care | Cleaning, debridement, infection control, bandaging, and pain management | Appropriate for all wounds | Strong. Remains the foundation of equine wound management. |
| Carbon dioxide therapy | Improves local oxygen delivery and tissue perfusion through increased COâ‚‚ exposure | Difficult-to-heal wounds, particularly those affecting the distal limbs | Limited but promising. Early studies show physiological effects and reduced early wound expansion, but larger clinical trials are needed. |
| Platelet-rich plasma (PRP) | Delivers concentrated platelets and growth factors to support tissue repair | Tendon and ligament injuries and selected wounds | Moderate. Used as an adjunctive regenerative therapy, although effectiveness varies with the condition being treated. |
| Stem cell therapy | Uses regenerative cells to promote tissue repair and modulate inflammation | Primarily tendon and ligament injuries, with investigational use for skin wounds | Moderate. Best supported for musculoskeletal injuries, with more limited evidence for cutaneous wound healing. |
| Red-light therapy (photobiomodulation) | Uses red and near-infrared light to stimulate cellular activity associated with tissue repair | Soft-tissue injuries, rehabilitation, and selected wounds | Limited. Like COâ‚‚ therapy, it is considered an adjunct rather than a replacement for conventional wound care. |
Different wounds require different treatment approaches, and carbon dioxide therapy may not be appropriate in every case.
Treatment decisions depend on factors such as wound location, severity, contamination, involvement of deeper structures, and the horse’s overall health.
Regardless of the adjunctive therapy used, appropriate wound cleaning, infection control, bandaging, and veterinary monitoring remain essential components of wound management. [1][7][8]
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is a regenerative treatment prepared from the horse’s own blood. The blood is processed to produce plasma containing a high concentration of platelets, which release growth factors and other proteins involved in inflammation, cell proliferation, collagen production, and tissue repair. [9][10]
The resulting preparation is usually injected directly into or around the affected tissue. Unlike CO2 therapy, which is intended to improve local perfusion and oxygen delivery, PRP supplies biological components that act directly on cellular repair processes. [9][10]
Although PRP is used most commonly for tendon and ligament injuries, it has also been investigated for equine skin wounds. Results are inconsistent, as one study found that PRP shortened healing time in distal-limb wounds and reduced the development of severe granulation tissue, while another found that it delayed healing and could promote excessive granulation tissue. [11][12]
Stem Cell Therapy
Stem cell therapy uses undifferentiated cells, most commonly mesenchymal stem cells, to support the repair of damaged tissues.
These cells may contribute to healing by differentiating into connective-tissue cells and by releasing growth factors and cytokines that influence inflammation and tissue regeneration. [13][14]
Stem cell therapy may not necessarily shorten the healing period, but it may improve the quality and organization of repaired tissue while limiting scar formation. This distinguishes it from CO2 therapy, which primarily targets local circulation and oxygen availability rather than supplying regenerative cells. [13][14]
Most equine evidence for stem cell therapy relates to tendon and ligament injuries, where some studies report improved fiber alignment, stronger repaired tissue, and lower reinjury rates. Potential applications also include chronic skin wounds, deep wounds in foals, and infected pressure sores, but these uses remain investigational. [15][16][17]
Red-Light Therapy (Photobiomodulation)
Red-light therapy, also known as photobiomodulation or low-level laser therapy, exposes tissues to red or near-infrared wavelengths of light. Red light primarily affects superficial tissues, whereas near-infrared light penetrates more deeply into structures such as muscles and joints.
The light is proposed to stimulate mitochondrial activity and increase cellular production of adenosine triphosphate (ATP), potentially supporting cellular repair, circulation, and control of inflammation and oxidative stress. [18][19]
Although both red-light and CO2 therapies may be used to support local circulation and tissue recovery, they act through different physical and cellular mechanisms. [18][19]
In wound management, photobiomodulation has been proposed to improve blood flow and stimulate tissue repair, support collagen production, potentially accelerate healing, and reduce scar formation. However, much of the supporting evidence comes from laboratory research, human medicine, or broader veterinary applications, and horse-specific clinical evidence remains limited. [19][20][21]
Treatment parameters have also not been standardized, and outcomes can vary according to wavelength, dose, exposure time, and the condition being treated.
Red-light therapy should therefore be viewed as a non-invasive adjunct, not as a substitute for veterinary assessment or conventional treatment of open, infected, or otherwise serious wounds. [19][20][21][22][23]
Risks & Limitations
Transcutaneous carbon dioxide (COâ‚‚) therapy is generally considered a low-risk, non-invasive treatment when performed with appropriate equipment under veterinary supervision. Unlike surgical procedures or injectable therapies, the treatment does not penetrate tissue, reducing the risk of additional trauma to the wound. [2][3][4]
Published equine studies have not reported significant treatment-related adverse effects, and horses have generally tolerated the procedure while standing without sedation. However, an absence of reported complications does not prove that the therapy is risk-free. [3][5]
Important limitations include: [3][4]
- Small study populations: Relatively few horses have been included in published studies, so uncommon adverse effects may not yet have been identified. Larger clinical trials are needed to better establish the treatment’s safety profile.
- No standardized treatment protocol: Questions remain about the ideal treatment duration, frequency, gas concentration, and wound types most likely to benefit. Protocols may therefore vary among veterinary hospitals and research centers.
- Limited availability and practical constraints: The treatment requires specialized equipment and is currently available through a limited number of veterinary hospitals and equine referral centers. Multiple sessions may also increase the time and cost involved compared with standard wound care alone.
Overall, transcutaneous carbon dioxide therapy appears to be a useful option for difficult wounds. However, current evidence supports its use as a complementary therapy within a comprehensive veterinary treatment plan rather than as a routine or stand-alone intervention. [2][3][4]
Frequently Asked Questions
Here are some frequently asked questions about carbon dioxide wound therapy for horses:
Carbon dioxide wound therapy for horses is a non-invasive treatment that exposes injured tissues to medical-grade carbon dioxide gas. The gas is applied around the affected area using a sealed chamber or specialized treatment bag. The treatment is intended to improve local blood flow and oxygen delivery, creating conditions that may support tissue repair. It is an investigational adjunct to conventional wound care, not a stand-alone treatment.
Carbon dioxide therapy may support wound healing by improving local circulation and encouraging hemoglobin to release more oxygen into injured tissues. This response, known as the Bohr effect, may increase the oxygen available for collagen production, new blood vessel formation, immune function, and skin repair. Carbon dioxide may also dilate local blood vessels, helping nutrients and immune cells reach the wound. These physiological effects are promising, but they have not been shown to accelerate healing in every horse.
Horse wounds that may benefit from carbon dioxide therapy include difficult-to-heal injuries, particularly wounds on the lower limbs. These areas have limited soft tissue coverage and circulation, and they are exposed to repeated movement and contamination. Carbon dioxide therapy may help improve the local healing environment, but there is not enough evidence to recommend it routinely for a particular wound type. A veterinarian must assess the wound's location, severity, contamination, and involvement of deeper structures before considering treatment.
Lower limb wounds in horses are difficult to heal because the area below the carpus and hock has little muscle or soft tissue and a relatively limited blood supply. Movement places repeated tension on healing tissues, while exposure to dirt, bedding, manure, and moisture increases the risk of contamination. These wounds are also prone to persistent inflammation and excessive granulation tissue. Together, these factors can delay wound contraction, skin formation, and overall recovery.
Research on carbon dioxide therapy in horses shows limited but encouraging early results. In one experimental study, larger treated wounds expanded less during the early stages of healing than untreated wounds. However, treatment did not significantly improve granulation tissue formation, microscopic healing scores, or skin graft outcomes. Larger clinical trials involving naturally occurring wounds are needed to determine whether the therapy consistently improves recovery.
Carbon dioxide therapy has not been proven to prevent or reduce proud flesh in horses. Although improved oxygen delivery and blood flow may influence tissue repair, equine research has not demonstrated a significant reduction in exuberant granulation tissue compared with untreated wounds. Proud flesh can interfere with new skin formation and may require veterinary management. Carbon dioxide therapy should not be relied upon as its primary treatment.
Carbon dioxide therapy cannot replace conventional wound care for horses. Wound cleaning, debridement, infection control, bandaging, pain management, and veterinary monitoring remain the foundation of treatment. Restricted exercise and medications may also be required depending on the injury. Carbon dioxide therapy may be considered only as an additional measure within a comprehensive veterinary treatment plan.
Carbon dioxide wound therapy is performed by enclosing the affected limb or body region in a sealed plastic chamber or specialized treatment bag. Medical-grade humidified carbon dioxide is then introduced for a predetermined period so the gas can pass through the skin into underlying tissues. Before treatment, a veterinarian should assess and manage infection, contamination, foreign material, and damage to deeper structures. Specialized equipment and trained veterinary supervision are required throughout the procedure.
Carbon dioxide therapy has typically taken about 30 minutes per session in equine experimental studies. Research protocols have used multiple sessions each week over several weeks. These schedules are experimental and are not established clinical recommendations. Treatment duration and frequency may vary based on the wound, the horse, and the protocol used by the veterinary facility.
A horse does not usually need sedation for carbon dioxide therapy. Horses in published studies generally tolerated the procedure while standing quietly with the affected limb enclosed in a treatment chamber. Sedation may still be considered based on the horse's temperament, the wound's location, and safety during handling. The attending veterinarian should make that decision for each horse.
Carbon dioxide wound therapy appears to be low risk when performed with appropriate equipment under veterinary supervision. Published equine studies have not reported significant treatment-related adverse effects, and the procedure does not penetrate tissues. However, only a small number of horses have been studied, so uncommon complications may not yet be recognized. The lack of standardized protocols also means that treatment methods can vary among veterinary facilities.
Carbon dioxide therapy differs from other equine wound treatments because it is intended to improve tissue oxygen delivery and local blood flow. Platelet-rich plasma supplies concentrated platelets and growth factors, stem cell therapy uses regenerative cells, and red light therapy stimulates cellular activity using red or near-infrared light. Evidence and appropriate uses vary among these therapies, and none replaces basic wound management. The best approach depends on the wound's location, severity, contamination, structures involved, and the horse's overall health.
A horse receiving carbon dioxide therapy still needs the same careful aftercare required for any significant wound. This may include regular cleaning and bandage changes, restricted exercise, a clean environment, and medications when prescribed by a veterinarian. Normal progress can include gradual wound contraction, reduced drainage, healthy pink granulation tissue level with the surrounding skin, and steady formation of new skin. Healing time depends on the wound's size and location, the structures involved, and the horse's general health.
A veterinarian should reassess a horse's wound promptly if it develops increasing swelling, heat, pain, discharge, or a foul odor. Veterinary attention is also important if the wound stops improving, begins to enlarge, develops excessive proud flesh, or causes worsening lameness. Wounds involving an exposed tendon, bone, or joint require prompt professional care. Fever, loss of appetite, depression, or other changes in general health can indicate a significant complication.
The main limitations of carbon dioxide therapy for horses are limited clinical evidence and the absence of standardized treatment protocols. Researchers have not yet established the ideal gas concentration, session frequency, treatment duration, or wound types most likely to benefit. Specialized equipment is available through only some veterinary hospitals and equine referral centers, and repeated sessions may increase time and cost. Until stronger evidence is available, the therapy should be regarded as an investigational addition to established wound care.
Summary
Transcutaneous carbon dioxide therapy is an emerging, non-invasive adjunct intended to improve blood flow and oxygen delivery in equine wounds. Early findings are promising, but larger clinical studies are needed to establish its effectiveness and ideal treatment protocols.
- Treatment exposes the affected area to humidified medical-grade carbon dioxide in a sealed chamber, typically for approximately 30 minutes
- Carbon dioxide may promote local vasodilation and encourage hemoglobin to release more oxygen into healing tissues
- Early equine research found reduced initial expansion in larger treated wounds but no significant improvement in several other healing measures
- Small study populations and the absence of standardized protocols limit conclusions about safety and effectiveness
- The therapy should complement veterinary wound cleaning, debridement, infection control, bandaging, and ongoing assessment
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