Patent Publication Number: US-2021186788-A1

Title: Device for transcutaneous application of carbon dioxide and a functioning method of the said device

Description:
FIELD OF THE INVENTION 
     The present invention belongs to the field of medical devices for treatment with carbon dioxide, more precisely to the field of devices for transcutaneous application of carbon dioxide. The invention also belongs to the field of piping, connections and valves for medical devices and medical use. The invention relates to a device for transcutaneous application of carbon dioxide for treatment of chronic wounds and/or neuropathy, as well as to a functioning method of the said device. 
     BACKGROUND OF THE INVENTION 
     CO 2  can be applied to treat a variety of disorders, mostly treatment for peripheral vascular disorders (Dogliotti et al, 2011, Int Angiol. 30(1):12-7.). The benefits of bathing in CO 2 -enriched water have been described (Hartmann et al, 1997, https://doi.org/10.1177/000331979704800406; Toriyama et al., 2002, Int Angiol. 21(4):367-73). It has been observed that CO 2  stimulates blood flow and microcirculation to increase partial O 2  pressure in local tissue, which is known as the Bohr effect (Irie et al, 2005, Circulation 111:1523-1529; Bohr et al., 1904, https://doi.org/10.1111/j.1748-1716.1904.tb01382.x). The Bohr effect indeed occurs in human body after transcutaneous administration of CO 2  as shown by Sakai et al. (2011, PloS One, 6, 9: e24137). More recently, CO 2  therapy has been found to induce mitochondrial apoptosis in human tumours, hence it has also been suggested for clinical testing for treatment of primary tumours (Oe et al, 2011, Biochem Biophys Res Commun 407: 148-152; Onishi et al, 2012, https://doi.org/10.1371/journal.pone.0049189; Takeda et al, 2014, PLoS One 9: e100530; Ueha et al, 2107, https://doi.org/10.3892/or.2017.5591). 
     Usually, CO 2  therapy is performed by bathing in CO 2  enriched water or by injection, wherein transcutaneous CO 2  application using 100% CO 2  gas is supported by applying CO 2  absorption-enhancing hydrogel (Onishi et al, 2012). Both known methods have disadvantages. CO 2  enriched water is prepared by supplying CO 2  in gaseous form from tanks, however the amount of CO 2  in water is small, due to potential danger of inhaling toxic amounts of CO 2 . It has been estimated that the concentration of CO 2  in the enriched water is only 0.1% and there is no evidence showing absorption in human body (Hashimoto et al, 2004, J Appl Physiol 96:226-232; Yamamoto et al, 2007, Int J Biometeorol 51:201-208). Further, such bathing is not suitable for hospital treatments and for patients with chronic or acute wounds. 
     A chronic wound is a wound that does not heal in a usual manner and it is widely accepted that wounds that do not heal within three months are considered chronic. Chronic wounds have different causes (ischemic, neuropathic, etc.) and may differ in the stage of healing in which they are detained. In some cases, such wounds may never heal or take years to do so. Delayed wound healing has also been linked to peripheral neuropathy, which is a condition where peripheral nerves are damaged and cause various unpleasant sensations, including pain. Peripheral neuropathy can be a result of several different causes—traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins, however one of the most common causes is diabetes. In patients with this metabolic condition, nerve damage tends to lead to a loss of sensation in limbs, usually feet. Wounds on the lower extremities are often overlooked, resulting in delayed wound care and untreated infection that, if it turns gangrenous, may need to be amputated to stop the spread. 
     Amputations could be decreased, limited or even prevented by improving blood flow and circulation in affected areas. As carbon dioxide has been known to exert these desired effects, there is a need for a device for transcutaneous application of carbon dioxide, which will allow safe treatment of neuropathy or chronic wounds without the need for bathing, injection or any supplemental hydrogel or water-based CO 2  carriers, which could deteriorate the state of wounds in diabetic patients. Thus, the technical problem solved by the present invention is construction of a device and all its parts, which will enable safe delivery of adequate amounts of CO 2  through the patient&#39;s skin for treatment. 
     Several different devices for trans- or subcutaneous delivery of CO 2  into human body are already known, but they use different approaches than the present invention. Mostly, the known solutions are for injection-based therapy (subcutaneous delivery). One such solution is disclosed at web page http://www.mbemedicale.it/en/prodotto/venusian-co2-therapy. This device is primarily intended for use in gynaecology for ultrasound scans where CO 2  is supplied into the abdominal cavity in order to separate the space between individual organs. Webpage available at the address https://www.alibaba.com/showroom/co2-carboxy-therapy-machine.html discloses a pen for cosmetic purposes that comprise CO 2  ampules. Such solutions do not deliver the needed amounts of CO 2  for successful treatments and the above described Bohr effect. Although subcutaneous CO 2  injections can deliver 100% CO 2 , they are invasive, involve risks for infection and are only local, meaning that coverage of larger parts of human body is challenging. 
     On the other hand, Sakai et al (2011, PloS One, 6, 9: e24137) used a device for transcutaneous CO 2  delivery comprising a wrap for covering a part of the body and allowing supply of 100% CO 2  together with a hydrogel, so that the supplied CO 2  remained in the wrap. Similar approach was used by Ueha et al (2017; https://doi.org/10.3892/or.2017.5591), where transcutaneous administration of CO 2  to the area of skin around the tumour was achieved with a CO 2  hydrogel. The area was then sealed with a polyethylene bag, and 100% CO 2  gas was delivered into the bag. 
     The solution shown on the web page https://www.airjectorvet.com/ comprises a bag placed around the part of an animal that has to be treated with CO 2 . The latter is introduced into the sealed bag with an especially adapted gun. After the treatment the CO 2  is released into the environment, which must be an open space to prevent intoxications with the gas. This solution differs from the present invention in many aspects, most importantly the gun does not allow introduction of concentrated CO 2  into the bag. Further, the present invention has a controlled release of CO 2  so that users of the device and the medical staff are safe. 
     SUMMARY OF THE INVENTION 
     The invention is intended for performing transcutaneous CO 2  application treatments of all kinds of chronic or acute wounds and conditions where the basic problem is insufficient blood supply. Transcutaneous CO 2  administration is enabled by law of diffusion from the part with high CO 2  concentration (chamber of the device) to the part with a lower CO 2  concentration (the patient&#39;s body or body part). By introducing significant amounts of CO 2  onto the patient&#39;s body or body part blood circulation is improved, as well as nutritive perfusion of the treated area, which is crucial for faster healing of chronic wounds and neuropathy. 
     In a broad aspect of the invention, a device comprises at least:
         a therapeutic chamber comprising at least a portion to receive a part of a patient&#39;s body to which the carbon dioxide is to be applied,   an inlet/outlet pipe connecting the chamber with a CO 2  distribution system, wherein the inlet/outlet pipe is connected to the chamber with a suitable element or a valve;   the CO 2  distribution system comprising a housing where at least the following components are installed:
           a first pipe with a first valve for suction of air out of the chamber,   a second pipe with a second valve for supplying CO 2  from a tank/reservoir; wherein the first and second pipe are combined into the inlet/outlet pipe upstream of the valves;   at least one device for ensuring air flow through the said valves and inlet/outlet pipe, preferably a ventilator or a pump;   preferably at least one airflow measuring device for measuring the air flow through the valve on the inlet/outlet pipe or through any valve;   preferably a reservoir for CO 2 , where it is stored at the pressure of 1 to 5 bar, connected to the second pipe;   an outlet pipe for leading the used air from the chamber through the wall to the external environment of the building where the device is installed; and   
           at least one tank for storing CO 2  suitably connected to the CO 2  distribution system or preferably to the reservoir.       

    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  An embodiment of the device according to the invention 
         FIG. 2  Detailed view of the device shown in  FIG. 1   
         FIG. 3A  Valves and piping inside the CO 2  distribution system connected to the chamber with the inlet/outlet pipe with two pipes 
         FIG. 3B  Valves and piping inside the CO2 distribution system connected to the chamber with the inlet/outlet pipe with three pipes 
         FIG. 4  The gate valve for supplying gas into the chamber from the inlet/outlet pipe 
         FIG. 5  Installation of the gate valve shown in  FIG. 4  into the chamber 
         FIG. 6  Outlet pipe with the telescopic intra-wall part 
         FIG. 7  installation of telescopic intra-wall part in the wall of a building 
     
    
    
     DESCRIPTION OF THE INVENTION 
     The invention is intended for performing transcutaneous CO 2  application treatments of all kinds of chronic or acute wounds and conditions where the basic problem is insufficient blood supply. Transcutaneous CO 2  administration is enabled by law of diffusion from the part with high CO 2  concentration (chamber of the device) to the part with a lower CO 2  concentration (the patient&#39;s body or body part). By introducing significant amounts of CO 2  onto the patient&#39;s body or body part blood circulation is improved, as well as nutritive perfusion of the treated area, which is crucial for faster healing of chronic wounds and neuropathy. 
     The essence of the device for transcutaneous application of carbon dioxide for treatment of chronic wounds or neuropathy is in that the device comprises at least:
         a therapeutic chamber comprising at least a portion to receive a part of a patient&#39;s body to which the carbon dioxide is to be applied,   an inlet/outlet pipe connecting the chamber with a CO 2  distribution system, wherein the inlet/outlet pipe is connected to the chamber with a suitable element or a valve;   the CO 2  distribution system comprising a housing where at least the following components are installed:
           a first pipe with a first valve for suction of air out of the chamber,   a second pipe with a second valve for supplying CO 2  from a tank/reservoir; wherein the first and second pipe are combined into the inlet/outlet pipe upstream of the valves;   at least one device for ensuring air flow through the said valves and inlet/outlet pipe, preferably a ventilator or a pump;   preferably at least one airflow measuring device for measuring the air flow through the valve on the inlet/outlet pipe or through any valve;   preferably a reservoir for CO 2 , where it is stored at the pressure of 1 to 5 bar, connected to the second pipe;   an outlet pipe for leading the used air from the chamber through the wall to the external environment of the building where the device is installed; and   
           at least one tank for storing CO 2  suitably connected to the CO 2  distribution system or preferably to the reservoir.       

     The outlet pipe is connected to the inlet/outlet pipe through the first pipe of the CO 2  distribution system. 
     The device can be further provided with a filter in the CO 2  distribution system to filter out any impurities and/or a silencer for decreasing the sound resulting from the flow of gas under pressure. Said filter is preferably installed in the pipe of the CO 2  distribution system between the ventilator and the inlet/outlet pipe. It is attached in any suitable way, usually with clamps. The silencer is preferably installed between the second valve and the ventilator. The CO 2  distributing system may have more pipes and valves, preferably one additional pipe with a valve is provided for delivering air to the chamber before it is filled with CO 2  in order to achieve CO 2  concentrations below 100%. 
     The device may be further equipped with suitable electronics for easier controlling and managing of the device, wherein the controller has suitable buttons connected with a control device that opens and closes the valves used in the CO 2  distribution system, so that any particular CO 2  concentration in the chamber may be achieved. 
     The chamber comprising at least a portion to receive a part of a patient&#39;s body to which the carbon dioxide is to be applied can be a flexible (soft) chamber such as a wrap or it can be designed as a chamber with supporting elements enabling a certain geometry of the chamber when it is filled with air and/or carbon dioxide. The chamber may have different sizes, wherein it can be appropriately small to receive only a foot, a part of a leg, a whole leg, an arm or a part of an arm or it can be bigger to accommodate the whole body of a patient with the exception of patient&#39;s head. Possible materials for the chamber are all biocompatible materials, which are not permeable to CO 2 , wherein the preferred choice is polyethylene, especially low-density polyethylene. The chamber is preferably for single use for hygienic reasons to prevent possible transfer of infections. 
     The inlet/outlet pipe to the chamber is only one, thereby rendering the construction of the device simpler. Further, its maintenance is easier. The inlet/outlet pipe is coupled to the chamber with a suitable passage valve (the gate valve), preferably the valve is comprising a rotating part and a static part, the latter being adapted for introduction into the inlet/outlet pipe. The rotating part has two removable parts, which are screwed into place from the interior of the chamber. Thereby the passage valve allows safe supply and suction of air to and from the chamber. When the chamber is flexible (soft) as a wrap, the gate valve is necessary. 
     The device can be preferably equipped with the reservoir for storing CO 2  at pressure from 1 to 5 bar. The reservoir is connected to the gas tank, where the gas is stored at pressures around 50 bars. Presence of the reservoir allows faster filling of the chamber, as the gas is already in gaseous state, at a suitable temperature and at suitable pressure. Namely, a part of the gas is led from the gas tank to the reservoir, where it due to a larger space expands, thereby also warming without any heaters. 
     Airtightness of the CO 2  distribution system inside the housing is ensured by using suitable seals and/or welding all metal components to each other, meaning that the valves are welded to the pipes, while the pipes are welded to the housing of the ventilator. The inlet/outlet pipe is connected to the system with a clamp and all attachments are provided with suitable seals, so that the CO 2  does not leak into the room where the device is used. The ventilator is preferably housed in a two-part housing welded together, wherein the housing is provided with a suitable number of holes for attachment of the required number of pipes. The valves may be any suitable, including electromagnetic or mechanic, controlled in any suitable way. The pipes are preferably metal, but can also be made of plastic materials, wherein welding is not possible but can be replaced with suitable seals such as rubber, silicon, Teflon and similar seals known in the art. 
     The outlet pipe for leading the used air from the chamber through the wall to the external environment of the building where the device is installed is preferably equipped with a telescopic transition for easy adjustment to a wide variety of walls, which often have different thicknesses. The telescopic transition may be extended or retracted depending on the wall, wherein its construction enables that it discharges the whole air from the chamber to the environment. The telescopic transition also seals the passage through the wall and prevents escape or return of the gas back into the room with the device according to the invention. The inner part of the telescopic transition may be provided with a seal, preferably installed on the flange of the inner part. 
     The first preferred embodiment of the device for transcutaneous application of carbon dioxide for treatment of chronic wounds or neuropathy is in that the device comprises:
         a therapeutic chamber comprising at least a portion to receive a part of a patient&#39;s body to which the carbon dioxide is to be applied,   an inlet/outlet pipe connecting the chamber with a CO2 distribution system;   the CO 2  distribution system comprising a housing where at least the following components are installed:
           a first pipe with a first valve for suction of air out of the chamber, and a first airflow measuring device for measuring the air flow through the first valve,   a second pipe with a second valve for supplying air to the chamber and a second air flow measuring device for measuring the air flow through the second valve,   a third pipe with a third valve for supplying CO 2  from a tank or a reservoir and a third air flow measuring device for measuring the air flow through the third valve;   
            wherein the first, second and third pipe are combined into the inlet/outlet pipe upstream of the valves;
           one ventilator, preferably two, for ensuring air flow through the said valves and inlet/outlet pipe,   preferably a reservoir for CO 2 , where the gas is stored at the pressure of 1 to 5 bar, connected to the third pipe;   an outlet pipe for leading the used air from the chamber through the wall to the external environment of the building where the device is installed; and   
           at least one tank for storing CO 2  suitably connected to CO 2  distribution system or preferably to the reservoir.       

     Said airflow measuring devices on individual pipes and valves may be replaced with one airflow measuring device installed on the inlet/outlet pipe and preferably also measuring the airflow through the gate valve. Every embodiment may be further equipped with a silencer and/or a filter and/or electronics for control. In case two ventilators are used, they are rotating in different directions with regards to the airflow (into the chamber or out of the chamber). 
     The second preferred embodiment of the device for transcutaneous application of carbon dioxide for treatment of chronic wounds or neuropathy is in that the device comprises:
         a therapeutic chamber comprising at least a portion to receive a part of a patient&#39;s body to which the carbon dioxide is to be applied,   an inlet/outlet pipe connecting the chamber with a CO 2  distribution system,   the CO 2  distribution system comprising a housing where at least the following components are installed:
           a first pipe with a first valve for suction of air out of the chamber,   a second pipe with a second valve for supplying CO 2  from a tank or reservoir;   wherein the first and second pipe are combined into the inlet/outlet pipe upstream of the valves;   a ventilator in a sealed housing for ensuring air flow through the said valves and inlet/outlet pipe,   preferably a reservoir for CO 2 , where the gas is stored at the pressure of 1 to 5 bar, connected to the second pipe;   preferably a silencer for decreasing the sound resulting from the flow of gas under pressure;   preferably a removable filter for filtering any impurities so that they do not reach the chamber;   an outlet pipe for leading the used air from the chamber through the wall to the external environment of the building where the device is installed; and   
           at least one tank for storing CO 2  suitably connected to the CO 2  distribution system or preferably to the reservoir.       

     Presence of at least two valves and suitable piping ensures that the carbon dioxide concentration is adapted to the needs of therapy. 
     The three valves (first, second, third) and at least one air flow measuring device in the first preferred embodiment enable controlling air composition inside the chamber, so that different CO 2  concentrations can be achieved. The preferred range of CO 2  concentration inside the chamber is 10 to 100%, wherein most preferred range is between 30 and 90%. For example, if a 30% (V/V) concentration is needed inside the chamber and the total volume of the chamber is 100 L, 70 L of air will be supplied through the second valve and 30 L of CO 2  will be supplied through the third valve. A 90% (V/V) concentration may be achieved by supplying 10 L of air through the second valve and 90 L of CO 2  through the third valve. 
     Preferably, the valves are controlled with a controller or a suitable computer/computer program in order to ensure correct CO 2  concentrations inside the chamber. The controller preferably has a button for emptying the chamber, which can turn on ventilator and open the first valve for air suction. All other valves are closed. When the chamber is completely empty, the ventilator is turned off and the first valve is closed. Then the actual volume of the chamber is determined by filling it with air, wherein information is obtained by measuring air flow. Based on the actual volume of the chamber the amount of air has to be pumped out and which amount of CO 2  has to be led into the chamber. When the chamber is full the operator stops filling by pressing a suitable button. After the therapy is done, a discharge button provided on the controller is pushed and this leads to the first valve being open and the second valve is closed, so that all air/CO 2  from the chamber is led to the exterior of the building. 
     The two valves and the airflow measuring device in the second preferred embodiment enable controlling of CO 2  concentrations inside the chamber so that the air is sucked from the chamber through the first pipe with the first valve and CO 2  is supplied from the tank or the reservoir to the chamber through the second pipe with the second valve. Thereby a CO 2  concentration near 100% is achieved in the chamber. If a lower concentration of CO 2  is required, the chamber is initially not emptied, but a certain amount of air may be left inside it. This embodiment has simpler operation and requires no electronics for control, although they are preferred. 
     The functioning method of the said device comprises the following steps:
         in case of flexible chamber, first attaching the chamber to the inlet-outlet pipe via the valve or the gate valve;   placing at least a part of patient&#39;s body into the chamber and sealing the chamber;   sucking out all air from the chamber with the first valve with a ventilator and leading all sucked air to the exterior of the building with the room where the device is used;   leading CO 2  from the tank to the CO 2  distribution system or preferably the reservoir for allowing the CO 2  to expand in the reservoir, which results in decrease of its pressure in an increase of its temperature;   closing the first valve and opening the second valve to supply a desired amount of air into the chamber and/or opening the third valve to supply a desired amount of 100% CO 2  into the chamber.       

     When the CO 2  administration is finished, the air with the CO 2  is sucked from the chamber through the outlet pipe and led outside of the building where the device is installed. When all air has been emptied from the chamber, it can be unsealed and removed, so that the patient may leave. Usually the therapy lasts for 10 minutes to up to 2 hours, wherein the length of each therapy can be adjusted based on the patient&#39;s state. 
     Use of the device is suitable for all patients with impaired microcirculation; especially but not limited to patients affected with: chronic and acute wounds, neuropathy, muscle tears, etc. 
     The invention has been tested on 47 patients (38 males and 9 females aged 65.4±12.0 years) with the total number of 61 diabetic wounds. Control group consisted of 26 patients (21 males and 5 females aged 66.5±10.7 years) with the total number of 31 diabetic wounds (median volume: 528 mm 3 , median area: 253 mm 2 ), who underwent placebo treatment with transcutaneous application of air. Experimental group consisted of 21 patients (21 males and 5 females aged 66.5±10.7) with the total number of 30 diabetic wounds (median volume: 351 mm 3 , median area: 241 mm 2 ), who underwent treatment with transcutaneous application of CO 2  using the invention. Testing lasted for 4 weeks and laser Doppler blood perfusion in foot skin microcirculation, heart rate and blood pressure measurements were carried out. Further, each subject underwent monofilament and vibration sensation tests. After the treatments following main findings were observed:
     1) 67% (20 out of 30) of all the wounds from the experimental groups were successfully healed, whereas the volume and area of the unhealed wounds on average decreased by 96% and 89%, respectively. None of the wounds from the control group was healed.   2) The results of the monofilament and vibration tests showed statistically significant improvement in terms of the sites with perceived monofilament/vibration stimulus for the experimental group.   3) Results of laser Doppler blood perfusion indicate that the function of the endothelial and neurogenic vascular tone regulating mechanisms of microcirculation improved significantly for the experimental group.   4) Absolute values of heart rate and arterial blood pressure before and after CO 2  therapies indicate that no systemic effects were caused during the treatment.   

     The device for transcutaneous application of carbon dioxide for treatment of chronic wounds or neuropathy, will be described in further detail based on possible embodiments and figures, which show: 
       FIG. 1  shows an embodiment of the device  1  according to the invention, the device  1  comprising the following:
         a therapeutic chamber  2  comprising at least a portion to receive a part of a patient&#39;s body to which the carbon dioxide is to be applied,   one inlet-outlet pipe  3  connecting the chamber  2  with a CO 2  distribution system  4 , wherein a gate valve  7  is preferably used, especially if the chamber  2  is flexible;   the CO 2  distribution system  4 ;   an outlet pipe  5  for leading the used air from the chamber  2  through a telescopic part  51  and an outlet  52  in a wall to the external environment of the building where the device is installed; and   at least one tank  6  for storing CO 2  suitably connected to the CO 2  distribution system.       

       FIG. 2  shows a detailed view of the preferred embodiment of the device, wherein CO 2  is provided from the tank into a reservoir  44  forming a part of the CO 2  distribution system. The CO 2  expands in the reservoir and can be then supplied to the chamber via the piping, valves and ventilator as described above. As said above, this enables that the CO 2  is at pressure 1 to 5 bar, which speeds up filling of the chamber. The CO 2  distribution system  4  has at least a first pipe  41  and a second pipe  42 , connected to a ventilator  43 , which is connected to the inlet/outlet pipe  3  with a pipe  45 , which is preferably equipped with a filter  45   a.  When the CO 2  administration is finished, the CO 2  is led out through the first pipe  41  to the outlet pipe  5  into the exterior of the building. 
       FIG. 3 a    shows a possible embodiment of the CO 2  distribution system comprising a housing where two pipes  41 , 42  are installed, each pipe having its own valve  41   a,    42   a,  and both pipes connected to the ventilator  43 , which is then connected to the inlet/outlet pipe  3  and consequently the chamber  2 . 
       FIG. 3 b    shows the preferred embodiment of the CO 2  distribution system comprising a housing where the following components are installed:
         a first pipe  41 ′ with a first valve  41 ′ a  for supplying CO 2  from the reservoir or the tank;   a second pipe  42 ′ with a second valve  42 ′ a  for supplying air from the environment;   a third pipe  42 ″ with a third valve  42 ″ a  for suction of air out of the chamber; wherein the said pipes are combined into the inlet/outlet pipe  3  upstream of the valves;   two ventilators  43 ′ and  43 ″ for ensuring air flow through the said valves and inlet/outlet pipe,   at least one airflow measuring device  41 ′ b,    42 ′ b,    42 ″ b  for measuring the air flow through the gate valve on the inlet/outlet pipe or through any valve;   the reservoir for CO 2 , where it is stored at the pressure of 1 to 5 bar, connected to the third pipe;       
     Pipes, valves, ventilator and the reservoir are connected airtightly with suitable welding and sealing. The valves may be any suitable valves such as electromagnetic or mechanical valves, wherein the gate valve has to be present in case the chamber is designed as a flexible wrap. 
     The gate valve  7  for connecting the inlet/outlet pipe  3  to the chamber  2  is shown in  FIG. 4  and it comprises:
         a rotating part  72 ;   preferably a washer  73 ;   a seal  74 ; and   a static part  71 , the latter being adapted for introduction into the inlet/outlet pipe;       

     wherein the rotating part has two removable parts, which are screwed into place from the interior of the chamber. The seal  74  is installed in the static part, while the washer prevents rotation of the chamber, when the rotating part is screwed into place with the static part  71 . The washer is especially useful for flexible chambers, while it is not needed in hard chambers. Preferably the gate valve is made of biocompatible medical grade plastics.  FIG. 5  shows installation of the gate valve  7 , wherein the rotating part  72  and the washer  73  are installed from the interior of the chamber, while the seal and the static part are installed from the direction of the inlet/outlet pipe  3 . The rotating part  72  and the static part  71  have corresponding treads, which can interlock so that air leakage is prevented. This is further ensured with the seal  74 . 
       FIGS. 6 and 7  show the telescopic intra-wall part  51  and its installation into the wall W. The telescopic part  51  comprises:
         an inner part  511 ; the inner part&#39;s flange optionally provided with a seal for improved sealing   an outer part  512 ;   a washer  513 ; and   a nut  514 .       

     The wall has to be equipped with a pre-prepared hole having a diameter between 10 mm to 100 m, into which the telescopic part  51  is installed. The smaller inner part  511  can move along the outer part  512 , wherein a threaded pole  511 ′ runs through the entire length of the telescopic part  51 . A second nut is provided for tightening. The telescopic part can be adjusted so that it corresponds to the thickness of the wall W into which it is to be installed. The outlet  52  can be performed in any suitable way. Air can travel through the telescopic part into the interior of the CO 2  distribution system, more precisely towards the first pipe  41 , or can travel to the exterior of the building when the therapy is over. 
     Within the scope of the invention as described herein and defined in the claims, other embodiments of the device for transcutaneous application of carbon dioxide for treatment of chronic wounds or neuropathy that are clear to person skilled in the art may be possible, which does not limit the essence of the invention as described herein and defined in the claims.