Is a plasma chair effective in treating chronic or non-healing ulcers, particularly in patients with conditions like diabetic foot ulcers or pressure ulcers?

Plasma Chair for Treating Ulcers

Do not use plasma chair (cold atmospheric plasma) for treating diabetic foot ulcers or pressure ulcers, as this intervention is strongly contraindicated by current guidelines due to lack of evidence for improving wound healing. 1, 2

Why Plasma Therapy Is Not Recommended

The International Working Group on the Diabetic Foot (IWGDF) provides a strong recommendation against using cold atmospheric plasma, ozone, nitric oxide, or CO2 compared to standard care for wound healing (Strong recommendation; Low certainty evidence). 1, 2, 3 This represents one of the few "strong" contraindications in diabetic foot ulcer management, meaning the evidence is clear enough that this intervention should be avoided entirely. 2

Similarly, for pressure ulcers, the American College of Physicians found insufficient evidence to assess the safety and efficacy of various physical therapies and advanced modalities, including plasma-based treatments. 1

What Should Be Used Instead

Core Treatment Principles

• Sharp debridement is the only debridement method with strong guideline support and should be performed at every dressing change to remove necrotic tissue, slough, and surrounding callus. 3, 4

• Complete pressure offloading is essential for plantar diabetic foot ulcers using non-removable knee-high devices (total contact cast or removable cast walker rendered non-removable), which are superior to removable devices. 1

• Basic moisture-balanced dressings such as hydrocolloid or foam dressings should be used to reduce wound size in both diabetic foot ulcers and pressure ulcers. 1

For Diabetic Foot Ulcers Specifically

• Ensure adequate vascular assessment, as ischemia is a barrier to healing and may require revascularization if ankle pressure <50 mmHg or toe pressure <30 mmHg. 4

• Control infection only when clinically present (increased pain, erythema, purulence, odor) - do not use antimicrobial dressings solely for wound healing. 2, 3

• Optimize glycemic control and assess for osteomyelitis in deep ulcers. 4, 5

For Pressure Ulcers Specifically

• Use electrical stimulation as adjunctive therapy to accelerate wound healing (Weak recommendation; Moderate quality evidence). 1

• Provide protein and calorie supplementation if the patient is malnourished (Weak recommendation; Low quality evidence). 1

When to Consider Advanced Therapies

Only after 2+ weeks of optimized standard care (adequate offloading, sharp debridement, basic dressings, vascular optimization, infection control) should you consider: 3

• Sucrose-octasulfate impregnated dressings for non-infected neuro-ischemic diabetic foot ulcers (Conditional recommendation; Moderate certainty). 1, 3

• Autologous leucocyte, platelet, and fibrin patch for non-infected diabetic foot ulcers that are difficult to heal (Conditional recommendation; Moderate certainty). 1, 3

• Systemic hyperbaric oxygen therapy for non-healing ischemic diabetic foot ulcers despite best standard care (Weak recommendation; Moderate certainty). 1

• Negative pressure wound therapy only for post-operative (surgical) wounds on the foot, not for chronic non-surgical ulcers (Weak recommendation; Low certainty). 1, 4

Critical Pitfalls to Avoid

• Failing to optimize standard care first - many clinicians prematurely use advanced interventions without ensuring adequate offloading, debridement, and basic wound care. 2

• Using antimicrobial dressings without documented infection - these should only be used for infection control, not to accelerate healing. 2, 3

• Inadequate debridement leaving necrotic tissue or callus in place, which prevents healing. 3, 4

• Partial offloading instead of complete pressure relief - this is insufficient for healing plantar ulcers. 4

Additional Interventions to Avoid

Beyond plasma therapy, the following should not be used for diabetic foot ulcers or pressure ulcers: 1, 2

• Growth factors, autologous platelet gels (except the specific leucocyte-platelet-fibrin patch)
• Bioengineered skin products as routine adjunct
• Physical therapies including ultrasound, magnetism, shockwaves
• Honey, collagen dressings, alginate dressings, topical phenytoin
• Pharmacological agents for perfusion enhancement, vitamin supplementation, or protein supplementation (for diabetic foot ulcers)
• Herbal remedies or topical antiseptics for wound healing