A single application of cold atmospheric plasma (CAP) improves blood flow parameters in chronic wounds

Schleusser, Sophie; Schulz, Lysann; Song, Jungin; Deichmann, Henriette; Griesmann, Anna-Catharina; Stang, Felix; Mailaender, Peter; Kraemer, Robert; Kleemann, Markus; Kisch, Tobias

doi:10.1111/micc.12754

Cited by 5 publications

(5 citation statements)

References 47 publications

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“…Twelve minutes subsequent to DBD-CAP treatment and remained elevated for the whole observation period of 60 min. This observation is in good agreement with findings in previous studies on intact human skin (+8% [23], +12% [24], +14% [25]), acute wounds in the human skin (+5% [43]), as well as chronic wounds in humans (+14% [44]), both in terms of qualitative (upregulation) as well as quantitative characteristics.…”

Section: Discussionsupporting

confidence: 92%

Topically confined enhancement of cutaneous microcirculation by cold plasma

Borchardt¹,

Helmke²,

Ernst³

et al. 2022

Skin Pharmacol Physiol

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Introduction: We aim to explore potentials and modalities of cold atmospheric pressure plasma (CAP) for the subsequent development of therapies targeting an increased perfusion of the lower leg skin tissue. In this study, we addressed the question whether the microcirculation enhancement is restricted to the tissue in direct contact with plasma or if adjacent tissue might also benefit. Methods: A dielectric barrier discharge (DBD)-generated CAP device exhibiting an electrode area of 27.5 cm² was used to treat the anterior lower leg of ten healthy subjects for 4.5 minutes. Subsequently, hyperspectral imaging (HIS) was performed to measure tempo-spatially resolved characteristics of microcirculation parameters in superficial (up to 1 mm) and deeper (up to 5 mm) skin layers. Results: In the tissue area covered by the plasma electrode, DBD-CAP treatment enhances most of the perfusion parameters. The maximum oxygen saturation (StO2) increase reached 8 %, the near infrared perfusion index (NIR) increases by a maximum of 4 %, and the maximum tissue hemoglobin (THI) increase equaled 14 %. Tissue water index (TWI) was lower in both the control and the plasma group thus not affected by the DBD-CAP treatment. Yet, our study reveals that adjacent tissue is hardly affected by the enhancements in the electrode area and the effects are locally confined. Conclusion: Application of DBD-CAP to the lower leg resulted in enhancement of cutaneous microcirculation that extended 1 h beyond the treatment period with localization to the tissue area in direct contact with the cold plasma. This suggests the possibility of tailoring application schemes for topically confined enhancement of skin microcirculation, e.g. in the treatment of chronic wounds.

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Section: Discussionsupporting

confidence: 92%

Topically confined enhancement of cutaneous microcirculation by cold plasma

Borchardt¹,

Helmke²,

Ernst³

et al. 2022

Skin Pharmacol Physiol

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“…In general, our results support the findings from previous studies applying a DBD source. Operated at conditions as intended by the manufacturer (referred to as 'standard') it was demonstrated that CAP treatment can enhance dermal microcirculation in intact skin of healthy subjects as well as in acute and chronic wounds [18][19][20][21][32][33][34]. Furthermore, our results confirm previously observed characteristics of upregulation of oxygen saturation (StO 2 ) and blood volume (THI) in those skin areas in direct contact with the plasma, peaking about 10-15 min after the intervention.…”

Section: Discussionsupporting

confidence: 87%

Which CAP components are relevant for enhancing dermal microcirculation in intact skin?

Borchardt,

Grams,

Emmert

et al. 2024

J. Phys. D: Appl. Phys.

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Cold atmospheric plasma (CAP) has been shown to be beneficial in various medical fields such as wound healing, oncology or dentistry. A prominent effect induced by CAP is the boost of microcirculation in human skin tissue. Being a complex cocktail of physical and chemically reactive components, the mechanisms by which CAP enhances microcirculation still remain unclear. Thus, this study aims to identify relevant CAP components involved in stimulation of dermal microcirculation. In a comparative approach, the application of the same CAP source was modified in such a way that three different treatment modalities could be realized, each with a characteristic composition of electrical current flow and concentration of reactive species. Microcirculation parameters oxygen saturation (StO2), tissue hemoglobin index, near-infrared perfusion index and tissue water index were recorded before and after each treatment on the lateral proximal left arm of 10 healthy volunteers by means of hyperspectral imaging. The maximum microcirculatory response to CAP was observed when all components were allowed to interact with skin tissue (standard treatment). In contrast, no upregulation was found as soon as electric currents and fields had been removed from the effective component spectrum. Application of the CAP source at reduced concentrations of reactive species compared to standard treatment led to significant but less pronounced enhancement of dermal microcirculation. The findings of this study indicate that a synergistic interplay of all CAP components promotes microcirculation in dermal tissue most effectively. Moreover, the findings support the hypothesis that electric currents and fields play a key role in enabling microcirculation boost whereas availability of reactive species in the gas phase is associated with the intensity of the tissue response to CAP treatment.

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“…Three biological effects of CAP are evidenced in the relevant literature: inactivation of a broad spectrum of microorganisms, including multi-drug-resistant microorganisms; increased cell proliferation and increased angiogenesis with a shorter period of CAP treatment; and apoptosis onset with a longer and more intensive treatment period, particularly for tumor cells [23]. What has been observed following treatments with physical plasma is the production of NO, a powerful vasodilator, due to the pH reduction in the treated tissue [71].…”

Section: Discussionmentioning

confidence: 99%

The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients

Bolgeo

Maconi

Gardalini

et al. 2023

JPM

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Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the ‘Scale for the Assessment of Narrative Review Articles’ (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses.

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A single application of cold atmospheric plasma (CAP) improves blood flow parameters in chronic wounds

Cited by 5 publications

References 47 publications

Topically confined enhancement of cutaneous microcirculation by cold plasma

Topically confined enhancement of cutaneous microcirculation by cold plasma

Which CAP components are relevant for enhancing dermal microcirculation in intact skin?

The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients

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