Cold atmospheric argon plasma treatment may accelerate wound healing in chronic wounds: Results of an open retrospective randomized controlled study in vivo
Introduction
Clinical trials using cold atmospheric plasma (CAP) technology have focused on use in chronic wounds as they are easily accessible to plasma devices and are commonly critically colonized or infected by bacteria. Plasma, the fourth state of matter in physics, consists of a combination of various reactive species, charged particles, ions, electrons, ultraviolet radiation (UV) and heat. The benefits of plasma in sterilization processes or for cauterization and coagulation are well recognized [1], [2]. In contrast, CAPs are not harmful to living tissue as they generate temperatures below 40 °C [3], [4], [5], [6], [7], [8].
The broad bactericidal spectrum of CAP devices has been demonstrated in vitro and in vivo [9], [10], [11], [12], [13], [14], [15], [16]. The development of bacterial resistance to plasmas is unlikely due to the mechanisms of action [8], [17]. The broad spectrum antibacterial effects of argon CAP treatments (MicroPlaSter alpha and beta) using 2 min or 5 min exposures have been reported in two prospective controlled clinical trials in patients with chronic infected wounds of various etiologies [10], [11]. It was therefore hypothesized that the reduction in bacterial load would lead to an improvement in wound healing.
In this open retrospective study, changes in wound dimensions (width and length) have been analyzed retrospectively in 70 patients with chronic ulcers due to a number of causes treated with the MicroPlaSter alpha device in addition to standard wound care.
Section snippets
Patient selection criteria
Patients with chronic infected wounds due to any reason attending the Department of Dermatology, Allergology and Environmental Medicine of Hospital Munich Schwabing, Germany, were invited to participate in the trial. Both inpatients and outpatients were included. Treatments were performed over a 4 year period from October 2005.
Wounds were either large enough for both plasma treatment and a control area of 3 cm² (including a separation zone of at least 0.5 cm) or there were multiple ulcers
Patient groups
Group A: 70 patients (32 females) with chronic wounds of various etiologies were treated. A total of 587 plasma treatments were performed, with an average mean of 8.4 per patient (range 4–39).
Table 1 summarizes the patient characteristics of all groups and includes a summary of the medical history of each group. Table 2 summarizes the wound characteristics of all groups.
Fig. 2 summarizes the primary etiology of the chronic wounds, with venous being the predominant cause (38.6%). The diagnosis
Discussion
This is the first study to evaluate the effect of cold atmospheric plasma treatment on wound healing effects in patients with chronic wounds in a retrospective open trial in which wound healing was not the primary endpoint, but secondary endpoint. We used as database the largest collective of patients treated with plasma so far using a single plasma source (MicroPlaSter alpha).
The study protocol in this first clinical trial in vivo was designed to evaluate the antimicrobial properties of CAPs
Conflict of interest statement
None.
Acknowledgments
We thank ADTEC Plasma Technology Co. Ltd, Hiroshima, for the allocation of the MicroPlaSter alpha. We are indebted to Delwyn Dyall-Smith, FACD, for proofreading the manuscript.
References (36)
- et al.
Treating the chronic wound: a practical approach to the care of nonhealing wounds and wound care dressings
J Am Acad Dermatol
(2008) - et al.
Evaluation of plasma skin regeneration technology in low-energy full-facial rejuvenation
Arch Dermatol
(2007) - et al.
Technology of argon plasma coagulation with particular regard to endoscopic applications
Endosc Surg Allied Technol
(1994) - et al.
Basic requirements for plasma sources in medicine
Eur Phys J Appl Phys
(2011) - et al.
Atmospheric-pressure plasma sources: prospective tools for plasma medicine
Pure Appl Chem
(2010) - et al.
Designing plasmas for chronic wound disinfection
New J Phys
(2009) - et al.
Focus on plasma medicine
New J Phys
(2009) - et al.
The plasma pencil: a source of hypersonic cold plasma bullets for biomedical applications
IEEE Trans Plasma Sci
(2008) - et al.
Plasma medicine: an introductory review
New J Phys
(2009) - et al.
Randomized two-sided placebo-controlled study on the efficacy and safety of atmospheric non-thermal argon plasma for pruritus
J Eur Acad Dermatol Venereol
(2013)
Successful and safe use of 2 min cold atmospheric argon plasma in chronic wounds: results of a randomized controlled trial
Br J Dermatol
A first prospective randomized controlled trial to decrease bacterial load using cold atmospheric argon plasma on chronic wounds in patients
Br J Dermatol
Cold atmospheric plasma: a successful treatment of lesions in Hailey–Hailey disease
Arch Dermatol
Contact-free inactivation of Candida albicans biofilms by cold atmospheric air plasma
Appl Environ Microbiol
Decolonisation of MRSA, S. aureus and E. coli by cold-atmospheric plasma using a porcine skin model in vitro
PLoS One
Effects of cold atmospheric plasmas on adenoviruses in solution
J Phys D: Appl Phys
Cold atmospheric air plasma sterilization against spores and other microorganisms of clinical interest
Appl Environ Microbiol
Test for bacterial resistance build-up against plasma treatment
New J Phys
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