Department of Plastic Surgery, Hand Surgery, Burn Unit, University Hospital of Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
Division of Interdisciplinary internal ICU, Medical Department I, University Hospital Leipzig, Germany.
Microvasc Res. 2021 Nov;138:104211. doi: 10.1016/j.mvr.2021.104211. Epub 2021 Jun 16.
Given the high prevalence of wounds and their challenging treatment, the research of therapies to improve wound healing is of great clinical interest. In addition, the general consequences of developing chronic wounds constitute a large health economic aspect, which underscores the interest in the development of efficient treatment strategies. Direct cold atmospheric plasma (di_CAP) has been shown to have beneficial effects on microcirculation of human tissue (Kisch et al., 2016a). It also affects microbial settlements, which may have supportive effects on wound healing processes (Balzer et al., 2015). To treat these adequately, in our view, the positive effects on wound healing should be objectified by application on standardized wounds. However, wound healing is a complex process, depending on nutrient and oxygen supply by cutaneous blood circulation. In spite of microcirculation has been shown to improve in healthy skin by CAP, a quantification of the effect in a standardized wound model has never been evaluated (Kisch et al., 2016a). Based on this, we hypothesize that CAP also influences the microcirculation in standardized acute wounds in a prospective cohort study.
Microcirculatory data of 20 healthy subjects (14 males, 6 females; mean age 40.85 ± 15.84 years; BMI 26.83 ± 7.27 kg/m2) were recorded continuously at a standardized acute wound after skin transplantation (donor site) at the thigh. Under standardized conditions, microcirculatory measurements were performed using a combined laser Doppler and photospectrometry system. After baseline measurement, CAP was applied by a dielectric barrier discharge (DBD) plasma device for 90 s to the acute wound area. Immediately after the application, cutaneous microcirculation was assessed for 30 min (min) at the same site.
After CAP application, tissue oxygen saturation immediately increased by 5% (92,66 ± 4,76% vs. Baseline 88,21 ± 6,52%, p < 0,01) in the first 60 s and remained significantly elevated for 4 min. Capillary blood flow increased by 19.3% within the first minute of CAP therapy (220.14 ± 65.91 AU vs. Baseline 184.52 ± 56.77 AU, p < 0.001). The statistically highly significant increase in blood flow continued over the entire measurement time. A maximum value was shown in the blood flow in the 15th minute (232.15 ± 58.90 AU, p < 0.001) according to CAP application. With regard to the output measurement, it represents a percentage increase of 25.8%. The measurement of post-capillary venous filling pressure at a tissue depth of 6-8 mm was 59.39 ± AU 12.94 at baseline measurement. After application, there were no significant changes.
CAP increases cutaneous tissue oxygen saturation and capillary blood flow at the standardized acute wound healing model. These results support recently published data on wound healing after CAP treatment. However, further studies are needed to determine if this treatment can improve the reduced microcirculation in chronic wounds. Moreover, repetitive application protocols have to be compared with a single session treatment approach.
鉴于伤口的高患病率及其治疗的挑战性，研究改善伤口愈合的疗法具有重要的临床意义。此外，慢性伤口的一般后果构成了一个巨大的健康经济方面，这凸显了开发有效治疗策略的兴趣。直接冷大气压等离子体（di_CAP）已被证明对人体组织的微循环有有益的影响（Kisch 等人，2016a）。它还影响微生物的定居，这可能对伤口愈合过程有支持作用（Balzer 等人，2015）。为了充分治疗这些伤口，我们认为，应通过在标准化伤口上应用来客观化对伤口愈合的积极影响。然而，伤口愈合是一个复杂的过程，取决于皮肤血液循环的营养和氧气供应。尽管已经表明 CAP 可以改善健康皮肤的微循环，但从未评估过在标准化伤口模型中的效果的定量（Kisch 等人，2016a）。基于此，我们假设 CAP 也会影响前瞻性队列研究中标准化急性伤口的微循环。
在大腿供体部位进行皮肤移植后，对 20 名健康受试者（14 名男性，6 名女性；平均年龄 40.85±15.84 岁；BMI 26.83±7.27kg/m2）的标准化急性伤口进行连续的微循环数据记录。在标准化条件下，使用激光多普勒和光光谱法系统进行微循环测量。在基线测量后，通过介电阻挡放电（DBD）等离子体装置将 CAP 应用于急性伤口区域 90s。应用后立即在同一部位评估皮肤微循环 30 分钟（min）。
CAP 应用后，组织氧饱和度在最初的 60 秒内立即增加了 5%（92.66±4.76%与基线 88.21±6.52%，p<0.01），并在 4 分钟内保持显著升高。CAP 治疗的第一分钟内，毛细血管血流增加了 19.3%（220.14±65.91AU 与基线 184.52±56.77AU，p<0.001）。整个测量时间内，血流的统计学显著增加持续存在。根据 CAP 应用，在第 15 分钟时显示出最大的血流值（232.15±58.90AU，p<0.001）。关于输出测量，它代表了 25.8%的增加百分比。在基线测量时，组织深度为 6-8mm 的毛细血管后静脉充盈压的测量值为 59.39±AU12.94。应用后，没有明显变化。
CAP 增加了标准化急性伤口愈合模型中的皮肤组织氧饱和度和毛细血管血流。这些结果支持最近关于 CAP 治疗后伤口愈合的研究数据。然而，需要进一步的研究来确定这种治疗是否可以改善慢性伤口中减少的微循环。此外，必须比较重复应用方案与单次治疗方法。
