Efficacy of Cold Atmospheric Plasma Therapy on Chronic Wounds: An Updated Systematic Review and Meta-Analysis of RCTs

Abstract

Objective. A previous meta-analysis has revealed that cold atmospheric plasma (CAP) might not be clinically beneficial to chronic wounds. However, several new randomized controlled trials (RCTs) reported that CAP was an effective treatment option for accelerating wound healing in chronic wounds. The purpose of this review is to incorporate these new results and evaluate the efficacy of CAP in chronic wounds. Methods. The major databases, including PubMed, Embase, Cochrane Library, and Web of Science, were searched for articles related to CAP treatment in chronic wounds until March 21, 2022. The literature retrieval and evaluation were carried out by two independent researchers. Result. A total of 13 randomized clinical trials published between 2010 and 2022 were finally included. CAP therapy showed to be more effective in reducing the area of wounds (mean difference (MD): -1.74, 95%; confidence interval (CI): [-3.14, -0.33], p = 0.02 ), compared with non-CAP treatments. The immediate reduction of the bacterial load was higher in the CAP group than in the control group. (MD: -0.37, 95%; CI: [-0.7, -0.05], p = 0.02 ). Conclusion. No significant changes were found in long-term antibacterial efficacy and pain perception between the two groups. However, more RCTs of excellent methodological quality are required to confirm technical details of the source of AP and the appropriate duration of the treatment with plasma.

Concise review of non‐invasive physical plasma as a promising treatment option for radiation injuries of the skin

“…Non‐invasive physical plasma (NIPP) is a promising treatment regimen for chronic wounds and other inflammatory dermatological disorders 8–10 . Therefore, it might also possibly be used to address radiation injury.…”

“…Hot physical plasma (about 70°C) has been established as an effective method to decontaminate medical devices and implants as well as for the cauterisation and dissection of tissue. NIPP, on the other hand, only reaches temperatures around 40°C and is being used with great success as a treatment modality in a growing number of dermatological disorders 8–10 . NIPP combines different and well‐established principles in treating skin diseases.…”

“…4,5 Non-invasive physical plasma (NIPP) is a promising treatment regimen for chronic wounds and other inflammatory dermatological disorders. [8][9][10] Therefore, it might also possibly be used to address radiation injury. NIPP is a highly energised gas that encompasses a combination of various biologically active reactive species (primarily reactive oxygen and nitrogen species), other radicals, ions and ultraviolet radiation (Figure 1).…”

“…NIPP, on the other hand, only reaches temperatures around 40 C and is being used with great success as a treatment modality in a growing number of dermatological disorders. [8][9][10] NIPP combines different and well-established principles in treating skin diseases. First, the formation of reactive species leads to a reduction of the bacterial load.…”

“…Further advantages of NIPP treatment are its non-invasive and virtually painless application, the absence of any relevant side effects, and the penetration of structures that are otherwise difficult to access due to its gaseous state. [8][9][10][11][12][13][14] Collateral radiation damage frequently occurs following the therapeutic use of ionising radiation as a part of cancer therapy. This socalled radiation dermatitis is the most common acute side effect of radiation treatment and majorly impacts the quality of life in many patients undergoing cancer treatment.…”