Ulrich C, Kluschke F, Patzelt A, Vandersee S, Czaika V A, Richter H, Bob A, Hutten J von, Painsi C, Hüge R, Kramer A, Assadian O, Lademann J, Lange-Asschenfeldt B
Department of Dermatology, Charité - University Medicine Berlin, Germany.
J Wound Care. 2015 May;24(5):196, 198-200, 202-3. doi: 10.12968/jowc.2015.24.5.196.
In the age of multiresistant microbes and the increasing lack of efficient antibiotics, conventional antiseptics play a critical role in the prevention and therapy of wound infections. Recent studies have demonstrated the antiseptic effects of cold atmospheric pressure plasma (APP). In this pilot, study we investigate the overall suitability of one of the first APP sources for wound treatment focusing on its potential antimicrobial effects.
The wound closure rate and the bacterial colonisation of the wounds were investigated. Patients suffering from chronic leg ulcers were treated in a clinical controlled monocentric trial with either APP or octenidine (OCT). In patients who presented with more than one ulceration in different locations, one was treated with APP and the other one with OCT. Each group was treated three times a week over a period of two weeks. The antimicrobial efficacy was evaluated immediately after and following two weeks of treatment.
Wounds treated with OCT showed a significantly higher microbial reduction (64%) compared to wounds treated with APP (47%) immediately after the treatment. Over two weeks of antiseptic treatment the bacterial density was reduced within the OCT group (-35%) compared to a slight increase in bacterial density in the APP-treated group (+12%). Clinically, there were no signs of delayed wound healing observed in either group and both treatments were well tolerated.
The immediate antimicrobial effects of the APP prototype source were almost comparable to OCT without any signs of cytotoxicity. This pilot study is limited by current configurations of the plasma source, where the narrow plasma beam made it difficult to cover larger wound surface areas and in order to avoid untreated areas of the wound bed, smaller wounds were assigned to the APP-treatment group. This limits the significance of AAP-related effects on the wound healing dynamics, as smaller wounds tend to heal faster than larger wounds. However, clinical wound healing studies on a larger scale now seem justifiable. A more advanced plasma source prototype allowing the treatment of larger wounds will address APP's influence on healing dynamics, synergetic treatment with current antiseptics and effects on multiresistant bacteria.
在多重耐药微生物时代以及高效抗生素日益匮乏的情况下，传统防腐剂在伤口感染的预防和治疗中发挥着关键作用。最近的研究表明了冷大气压等离子体（APP）的抗菌作用。在这项试点研究中，我们研究了最早用于伤口治疗的一种APP源的整体适用性，重点关注其潜在的抗菌效果。
研究伤口闭合率和伤口的细菌定植情况。患有慢性腿部溃疡的患者在一项临床对照单中心试验中接受APP或奥替尼啶（OCT）治疗。在不同部位出现多处溃疡的患者中，一处用APP治疗，另一处用OCT治疗。每组每周治疗三次，为期两周。在治疗后立即以及治疗两周后评估抗菌效果。
治疗后立即观察发现，与接受APP治疗的伤口（47%）相比，接受OCT治疗的伤口微生物减少率显著更高（64%）。经过两周的抗菌治疗，OCT组的细菌密度降低了（-35%），而APP治疗组的细菌密度略有增加（+12%）。临床上，两组均未观察到伤口愈合延迟的迹象，且两种治疗的耐受性都良好。
APP原型源的即时抗菌效果几乎与OCT相当，且没有任何细胞毒性迹象。这项试点研究受到当前等离子体源配置的限制，狭窄的等离子体束难以覆盖较大的伤口表面区域，为避免伤口床出现未治疗区域，较小的伤口被分配到APP治疗组。这限制了APP对伤口愈合动态影响的意义，因为较小的伤口往往比较大的伤口愈合得更快。然而，现在进行更大规模的临床伤口愈合研究似乎是合理的。一种更先进的允许治疗更大伤口的等离子体源原型将解决APP对愈合动态的影响、与当前防腐剂的协同治疗以及对多重耐药细菌的影响。
