The antimicrobial and tissue healing efficacy of the atmospheric pressure cold plasma on grade III infected pressure ulcer: randomized controlled in vivo experiment

Aim To evaluate the antimicrobial efficacy and wound healing effect of atmospheric pressure cold plasma (APCP) on an infected pressure ulcer (IPUs) model that was created on rats. Methods A total of 18 rats was divided into APCP, silver sulfadiazine (AgS) and control groups to have six rats in each group. A third-grade pressure ulcer model was developed on the back of each of the rats, and pressure ulcers were infected by inoculation of multidrug resistance (MDR) Pseudomonas aeruginosa. A portable dielectric barrier discharge device was used to generate cold air plasma. APCP, AgS and saline treatments were carried out once a day for 14 days. The effectiveness of the treatment was evaluated on days 5, 10 and 15. Surface area, depth, pressure ulcer healing scale (PUSH) and microbiological examination were used for evaluation. Results The results of this study showed that APCP was superior over AgS application and irrigation with saline by means of the reduction in surface area and depth of ulcers. Furthermore, PUSH score in plasma group was lower than other groups and histopathological examination showed a higher epithelization in APCP group. The average reductions of MDR P. aeruginosa for APCP, AgS and control groups were determined as 5.64 +/- 1.87, 1.91 +/- 0.90 and 1.22 +/- 0.88 log10 CFU per gram tissue, respectively. Conclusion Atmospheric pressure cold plasma healed IPUs better than AgS. Significance and Impact of the Study Portable cold plasma devices could be a potential novel treatment modality for the patients who have IPUs.