What is the role of Argon (Ar) and Nitrogen (N2) plasma devices in enhancing wound healing in patients with chronic wounds?

Role of Argon and Nitrogen Plasma Devices in Chronic Wound Healing

There is insufficient evidence to recommend argon or nitrogen plasma devices for enhancing wound healing in chronic wounds over standard care, though they show promise for bacterial load reduction in infected wounds. 1, 2, 3

Current Evidence on Plasma Devices

Efficacy for Bacterial Reduction

• Cold atmospheric plasma (CAP) therapy using argon has demonstrated significant antimicrobial properties:
  • 34% reduction in bacterial load with 5-minute daily treatments 2
  • 40% reduction with 2-minute treatments using MicroPlaSter alpha device 3
  • 23.5% reduction with 2-minute treatments using MicroPlaSter beta device 3
  • Effective against multidrug-resistant bacteria with 100% eradication in 64.7% of cases 4

Mechanism of Action

• Argon plasma devices work through multiple mechanisms:
  • Antimicrobial activity against biofilm
  • Generation of reactive nitrogen and oxygen species
  • UV radiation and electrical current effects
  • Tissue-stimulating properties
  • Blood flow promotion
  • Anti-inflammatory effects 1

Comparison to Established Wound Therapies

Negative Pressure Wound Therapy (NPWT)

Current guidelines provide more robust recommendations for NPWT than for plasma therapy:

• NPWT is conditionally recommended for post-surgical diabetic foot wounds 5
• NPWT is not recommended for non-surgical chronic wounds 5
• NPWT has moderate desirable effects for post-surgical wounds but insufficient evidence for chronic ulcers 5

Other Advanced Therapies

• Topical oxygen therapy has stronger evidence with several high-quality RCTs supporting its efficacy in chronic diabetic foot ulcers 5
• Hyperbaric oxygen therapy has conflicting evidence and is not clearly recommended for chronic wounds 5

Clinical Application Considerations

Safety Profile

• Plasma therapy appears to be well-tolerated with no reported side effects in clinical studies 2, 3
• Treatment sessions are typically short (2-5 minutes) and painless 3

Limitations of Current Evidence

• Most studies on argon plasma are small with methodological limitations
• Long-term outcomes and effects on complete wound healing (not just bacterial reduction) are not well established
• No major guidelines currently recommend plasma therapy for routine wound care

Practical Recommendations

1. Primary approach: Focus on established standard wound care protocols including:

   • Appropriate debridement
   • Infection control
   • Moisture balance
   • Offloading (for diabetic foot ulcers)
   • Addressing underlying vascular issues

2. Consider plasma therapy: As an adjunctive treatment for infected chronic wounds that are not responding to standard antimicrobial approaches, particularly when multidrug-resistant organisms are present

3. Treatment protocol: If using argon plasma, current evidence suggests 2-5 minute treatments can significantly reduce bacterial load 2, 3

Pitfalls and Caveats

• Do not substitute plasma therapy for essential standard wound care practices
• Bacterial reduction does not necessarily translate to improved wound healing outcomes
• Cost-effectiveness data for plasma therapy is lacking compared to other modalities
• Availability of plasma devices may be limited in many clinical settings
• Different plasma devices may have varying efficacy profiles

While argon plasma shows promise for bacterial reduction in chronic wounds, more robust clinical trials are needed before it can be recommended as a standard treatment for enhancing wound healing outcomes.