The gold standard for the treatment of chronic wounds is thus obsolete.
Once the leg is open, patients often begin a long journey of suffering. Despite cleaning of the chronic wound, special dressings and regular dressing changes according to current guidelines, it often takes many weeks and months for the skin to heal. In the multicenter study ,,Plasma On Chronic Wounds for Epidermal Regeneration", POWER for short, a study team from the Ruhr University Bochum together with other centers (including Berlin, Hamburg, Munich) compared treatment according to the gold standard with additional treatment with a cold plasma. An interim evaluation shows that the plasma significantly accelerates wound healing and reduces pain and infections. The interim results were published in the Journal of Clinical Medicine on August 4, 2023, and presented in a press conference at the Reichstag building in Berlin on September 12, 2023.
Not yet healed after eight weeks
Wounds that have not completely healed after eight weeks are considered chronic. The elderly, diabetics, and people with circulatory problems or mobility impairments are particularly often affected. The current guidelines for the treatment of such wounds include surgical debridement to remove necrotic tissue, antiseptic wound cleansing, the application of special dressings and regular dressing changes," explains Nessr Abu Rached, a specialist at the Clinic for Dermatology, Venereology and Allergology of the Ruhr University Bochum at St. Josef Hospital, Klinikum der Ruhr-Universität Bochum.
In the POWER study, which has been running since 2021 and will end at the end of 2024, the researchers are comparing the effect of this gold standard therapy with the application of a cold plasma. In this case, the ambient air between the wound and the plasma foil is partially ionized, i.e. charged with additional energy. The resulting plasma has antibacterial and antiviral effects as well as anti-inflammatory effects. Various previous studies have also shown that the plasma is capable of promoting the formation of new blood vessels. "This should also improve wound healing," says Nessr Abu Rached.
Three times a week two minutes of plasma
The study team recruited 48 patients in the study period to date, whose data could already be analyzed. They were randomly assigned to one of two groups. One group received gold standard care, while the other group also received two minutes of cold plasma three times a week for four weeks. The plasma applicator used in the study was comparatively large with an area of eleven by eleven centimeters. After four weeks, three months and six months, the researchers evaluated the wounds of the participants, for example by determining their size and possible colonization with bacteria and asking the patients how painful the wound was.
Result: 16 percent of the wounds in the plasma group had closed completely or almost completely (90 percent) after four weeks. In the control group with standard wound therapy, this was not true for a single wound. Another 28 percent of the wounds in the plasma group had reduced in size by at least 60 percent; this was also true for none of the wounds in the control group. A reduction in wound area of at least 40 percent was observed in 40 percent of the plasma group and in 18 percent of the control group.
In addition, the plasma group required significantly fewer antibiotics (4 percent versus 23 percent) compared to the control group. "Patients treated with plasma also reported a significant reduction in wound pain and an improvement in quality of life," reports Nessr Abu Rached. "The combination of plasma with proven wound treatment exceeds the effect of what was previously considered the gold standard treatment many times over," he concludes.
Nessr Abu Rached, Susanne Kley, Martin Storck, Thomas Meyer, Markus Stücker: Cold plasma therapy in chronic wounds - A multicenter, randomized controlled clinical trial (Plasma on chronic wounds for epidermal regeneration study): Preliminary results, in: Journal of Clinical Medicine, 2023, DOI: 10.3390/jcm12155121.