Case Study: canine decubitus ulcers

Submitted by Joyce Harman, DVM, February 28, 2018

PATIENT INFORMATION: Sunny - Female Spayed, Australian Shepard Mix, 13.5 years old

SUMMARY: Transdermal CO2was used as a primary treatment for decubitus ulcers. Sunny developed severe decubitus ulcers on both hips during the summer months. Transdermal CO2 significantly improved the healing despite ongoing problems with hot weather and the difficulty in keeping any dressing on the wounds.


Summer 2018: Sunny developed incontinence that did not respond well to treatment (herbal, homeopathic and subsequently Diethylstilbestrol). She has a very thick coat and insisted on laying on concrete, brick or hard wood floors, consequently developed full thickness decubitus ulcers on both hips where she had lost muscle from degenerative joint disease in her hips. The ulcers were difficult to treat since she lay on hard surfaces and it was too hot to cover her with a wrap to protect them. Topical treatments did not remain on for very long before she licked them off. She was also diagnosed with Lyme disease (blood test) in August. She responded to antibiotic treatment (amoxicillin and clavulinic acid) with improved mobility but developed a poor appetite and lost weight. The ulcers were failing to heal.

September 2018: Sunny was placed on Doxycycline for 3 weeks in September to treat the Lyme disease. Her appetite was extremely poor, and she became emaciated while on the antibiotic. She was moving better and seemed less sore around the ulcers. However, the edges of the ulcers were not healing.

TREATMENT: Transdermal CO2 treatment was started mid-September 2019. Her hindquarter and legs were placed in a plastic sleeve with a one-way valve. The air was evacuated from the bag and sealed with Vetrap®. CO2 was added to the bag through the valve and allowed to sit for 20 minutes. This was done for 3 days in a row, then approximately 3 times a week


The antibiotics had failed to promote wound healing, despite reducing the inflammation and drainage from the ulcers. The edges of the wounds showed little epithelialization until the transdermal CO2 treatments began. The edges were inflamed and moist. 

The day after each transdermal treatment, the appearance of the wound improved. Small amounts of epithelization could be seen and the drainage from the wound was less. After 2 weeks of treatments, the owner went out of town and therapy stopped. The owner then became very ill, so the therapy was not restarted. However, during this time the wounds slowly continued to heal, but the left one remained tender to the touch.


Decubitus ulcers on the hips of dogs are notoriously difficult to heal, due to the ability of the dog to remove any dressing that is placed on a hip. In the hot summer it was not possible to cover the hips with a blanket to hold a dressing in place. It was also impossible to use an Elizabethan collar in the home environment and summer heat. 

In this case the lesion’s edges were inactive until the addition of the transdermal CO2. Topical treatments had been tried but the dog licked them off almost immediately. The improvement in healing was noticeable from the start. The environmental and logistical conditions did not change, just the treatment. The ulcers were on track to heal when the owner had to stop treatment due to a personal illness and surgery. This was a set-back and does not allow a complete case to be presented, since complications occurred after the owner returned home.

The results that were obtained, however, indicate that transdermal CO2 can be useful in non-healing wounds such as decubitus ulcers. The treatment does not require bandaging, which can be beneficial in many circumstances. 

SUMMARY: Transdermal CO2 applied inside a plastic sleeve enhanced the healing of two decubitus ulcers on the hips of a dog. No bandages were needed. The treatment was non-toxic, easy to administer and improved the healing of the ulcers.