| Objective: Acute and chronic skin wounds occupy a very high proportion in clinics,including diabetic foot ulcers,bedsores,cancerous ulcers,and postoperative wound infections,etc.The effect of conventional treatment is not always satisfactory,chronic/non-healing wounds not only increase the burden of health care,but also have an impact on social development.Studies by domestic and foreign teams have shown that cold atmospheric plasma(CAP)can promote the healing of acute and chronic skin wounds,but different plasma equipment have different therapeutic effects.In this study,we used hand-held and desktop CAP instruments(using air as the plasma source)to treat common refractory bacteria on skin wounds,treat skin lesions of wound model rats and common skin wounds,the safety and clinical efficacy were evaluated,in order to provide a new and effective method for the treatment of skin wounds.Methods: We developed the medical hand-held and desktop CAP therapeutic instruments.CAP therapeutic instrument was used to irradiate four common refractory bacteria(Staphylococcus aureus,Pseudomonas aeruginosa,Escherichia coli,and Acinetobacter baumannii)on skin wounds,the number of surviving bacteria was observed after 30 s,60 s,90 s,120 s,and 180 s.The normal skin of rats was irradiated with 100% intensity(1.8 J),80% intensity(0.8 J)and 60% intensity(0.4 J)CAP for30/20/10/5 min,the skin reaction of immediately,24 h and 48 h after treatment were observed.We constructed trauma(superficial second-degree burn)model,and the scalded surface was treated with scald cream(positive control group),low-intensity CAP,medium-intensity CAP,and high-intensity CAP,respectively.The positive control group was given scalding ointment with the frequency of once a day,CAP groups were given 3 min CAP irradiation with the frequency of once a day,and the wound healing degree was observed on the 1st,3rd,5th,10 th,and 15 th days after treatment.Skin wound patients(chronic eczema,wounds after holmium laser treatment,trauma,stasis dermatitis,etc.)who are ineffective in traditional treatment methods were recruited from our Outpatient and Inpatient departments for CAP treatment,the changes in wound healing,the improvement of itching,pain,and other subjective symptoms were observed,the efficacy and safety of CAP in promoting the healing of different types of acute and chronic skin wounds were evaluated.Results:(1)CAP has in vitro sterilization effect on four common refractory bacteria on skin wounds.After 24 h of culture,the initial bacterial count of the four bacteria was 6.0log10 CFU/ml.With the prolongation of CAP treatment time,the number of viable bacteria gradually decreased.When the treatment time was 90 s and the soaking time was 30 min,the remaining number of viable bacteria was about 4.0log10 CFU/ml.When the treatment time was 180 s and the soaking time was 30 min,almost 100% of the bacteria were killed except Acinetobacter baumannii.(2)Different intensities and different lengths of time of CAP were used to irradiate the normal skin on the back of rats,and the results showed that: When the CAP intensity was 100% and the irradiation duration was 30 min or 20 min,obvious erythema or edema appeared in the skin lesions on the experimental site of rats;when the irradiation time was 10 min,erythema appeared on the skin of the experimental site of rats,and the degree was relatively mild;when the irradiation time was 5 min,the skin of the experimental site appeared slight erythema within a short period of time(1h),and recovered to normal after 24 h and 48 h.When CAP intensity was 80% and irradiation duration was 30 min,skin erythema or edema or both appeared in the experimental site of rats;when the irradiation time was 20 min,skin edema appeared in the experimental site of rats;when the irradiation time was 10 min or 5 min,there was no obvious abnormality in the skin of the experimental site.When CAP intensity was 60% and irradiation duration was 30 min,the skin of the experimental site of rats showed slight erythema within 1h after treatment,and erythema disappeared 24 h and 48 h after treatment;when the irradiation duration was 20/10/5 min,no obvious abnormality appeared on the skin of the experimental site.(3)In the treatment of the superficial second-degree scald model in rats,it was found that with the increase of treatment time,the wounds of rats in the CAP treatment groups and scald ointment group gradually healed.After10 days,it was observed that the wounds of most rats shrunk significantly,and even healed,especially in rats of moderate-intensity and high-intensity CAP treatment groups.There was no statistical difference of curative effect between CAP treatment groups and scald ointment group,indicating that CAP has a similar therapeutic effect in the treatment of superficial second-degree scald as the scalding ointment.In addition,there was no statistically significant difference of wound healing among low-intensity,medium-intensity,or high-intensity CAP treatment groups.(4)31 cases of refractory skin wounds(including 2 cases of pyoderma gangrenosum,1 case of diabetic foot,3cases of stasis dermatitis,2 cases of inverse psoriasis,2 cases of psoriasis vulgaris,5cases of eczema,2 cases of irritant dermatitis,2 cases of trauma,6 cases of post-laser wounds,and 5 cases of skin tumors(1 case was post-tumor wound),and 1 case of post-freezing wound)were received CAP treatment.After 2-24 times of CAP treatments,26 patients were cured or treated effectively,and 5 patients showed no improvement(1 patient with stasis dermatitis,1 patient with laser postoperative wound,and 3 patients with eczema).Among these 31 patients,only 1 patient experienced aggravation of itching symptoms,and no other adverse reactions were observed during the treatment.Conclusions:(1)CAP has a sterilization effect on Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumannii.(2)The normal skin of rats exposed to CAP irradiation with low intensity and short duration would not show erythema or edema,while the erythema and edema would appear in the normal skin of rats exposed to CAP irradiation with high intensity and long duration.Meanwhile,the severity and probability of skin reaction would increase with the extension of irradiation time and the enhancement of intensity.(3)CAP has similar therapeutic effect to burn cream in the treatment of superficial second-degree scald,and there is no statistical difference of wound healing in low intensity,medium intensity or high intensity CAP groups.(4)CAP can promote the healing of various acute and chronic skin wounds with mild adverse reactions,and has a positive impact on shortening the course of treatment and changing the prognosis.(5)CAP is expected to become a new,economical,and safe method for wound treatment. |
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