Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

Abstract

The use of atmospheric low‐temperature plasma (AP) on chronic wounds and its effect on microbial bioburden in open wounds has not been explored with a systematic review and meta‐analysis. PRISMA guidelines were followed and PubMed, Embase, CENTRAL, and CINAHL databases searched for randomised controlled trials (RCTs), which compared AP with no AP for the management of open, chronic wounds. The primary outcomes of reduction of bioburden or wound size were included. Meta‐analyses were performed; odds ratio (OR) and 95% confidence intervals (CIs) were extracted and pooled in a random effects model. Four RCTs investigated the effect of AP on chronic wound healing. Chronic wounds treated with AP did not show a significant improvement in healing (AP vs control: OR = 1.46; 95% CI = 0.89‐2.38; P = 0.13). Five further RCTs investigated the reduction of bioburden in wounds, but AP demonstrated no significant reduction of bioburden (AP vs control: OR = 0.85; 95% CI = 0.45‐1.62; P = 0.63). All nine RCTs recorded the presence of any severe adverse events (SAEs) in the 268 patients studied, with only one unrelated SAE identified in each group (AP vs control: OR = 1.00; 95% CI = 0.05‐19.96; P = 1.00). Use of AP in wound care is safe, but the retrieved evidence and meta‐analysis show that there is no clinical benefit of AP in chronic open wounds using currently available AP device settings.

Activation of the Normal Human Skin Cells by a Portable Dielectric Barrier Discharge-Based Reaction-Discharge System of a Defined Gas Temperature

“…For that reason, alternative wound healing therapies have been searched and extended. Very recently, special attention has been paid to the use of cold atmospheric pressure plasma (CAPP) in dermatology, thanks to the ability of these ionized-gas sources is to improve the wound healing process [5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Over the past few years, the interest of the controlled applications of CAPPs has rapidly increased. They include not only the utilization of CAPPs in dermatology [5][6][7][8][9][10][11][12][13][14][15][16][17][18], but also application of CAPP in the synthesis of nanomaterials [19][20][21], the germination of seeds [22], inhibiting the proliferation of cancers cell lines [23,24], and so on. This is possible because CAPP operation results in the generation of different reactive oxygen species (ROS, i.e., O 3 , H 2 O 2 , O•, O − 2 , OH•) and reactive nitrogen species (RNS, i.e., NO, NO 2 ), in addition to the emission of UV radiation and heat [7-9, 18, 25, 26].…”

“…To date, a few reaction-discharge systems have been developed for further applications comprise medicine and dermatology. These reaction-discharge systems include dielectric barrier discharges (DBDs) [14,15], corona discharges (CDs) [37], microwave-induced plasmas (MIPs) [11,12], and plasma jets named kINPen [5,[7][8][9][10]17] or COST [38,39], in addition to the non-thermal atmospheric pressure plasma jets studied and utilized by e.g. Rad et al [40], Gidon et al [41,42], Darmawati et al [43], Cheng et al [44], Busco et al [45].…”

Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology

“…The promising role of CAP as a medical approach has also been described in dermatology, including the impact of CAP on atopic dermatitis, pruritus, or psoriasis [190]. Several studies demonstrated the positive effect of CAP on the eradication of bacterial infection in chronic wounds associated with the promotion of healing processes [191]. Cold plasma successfully eliminated bacterial colonisation in patients with chronic leg ulcers [19], chronic wounds [192], or chronic venous leg ulcers [193], and resulted in enhanced healing of chronic wounds.…”

Plasma Permeabilization of Human Excised Full-Thickness Skin by µs- and ns-pulsed DBD

“…Since it is ideally suited to the treatment of surfaces, the fields of plasma medicine and plasma cosmetics often target the skin, healthy or diseased. CAP is already employed in the treat-DOI: 10.1159/000505195 ment of chronic wounds [2][3][4] and tested for the treatment of superficial tumors [5], warts [6], and many other indications as well as for cosmetic applications, such as skin rejuvenation [7,8].…”