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Wound management with cold plasma therapy
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Cold atmospheric pressure plasma therapy is an emerging technology in the veterinary field; this paper offers an introduction to the novel procedure and how it can benefit the canine patient.
Christoph J. Klinger
Dr. med. vet.
Dr. Klinger graduated from Munich in 2011 and worked in small animal practice before undertaking a year-long internship at Ludwig Maximilian University. He then completed an ECVD- and ACVD-approved residency in Munich and was awarded his doctoral thesis in 2016.
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Key points
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Cold plasma therapy is a simple, painless treatment method that efficiently eliminates infectious agents and accelerates the wound-healing process.
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Although CAPP can be very effective against multi-resistant bacteria, it does not eliminate any underlying cause, and must not replace a clinical diagnosis.
Introduction
Given the worldwide rising number of drug-resistant bacterial and fungal infections, it is becoming increasingly important to develop alternative treatment options for such infectious pathogens. Progress towards sustainable physical or other methods that can eliminate such problematic agents appears ever more crucial, and Cold Atmospheric Pressure Plasma (CAPP) Therapy is such a procedure, offering proven efficiency in treating antibiotic-resistant bacterial, viral and fungal pathogens (1, 2, 3, 4, 5). The technique also modifies and upregulates numerous factors that promote and accelerate healing, which can especially benefit patients with wound-healing disorders (6,7). Originally used in human medicine, CAPP is now becoming more widely accepted in veterinary medicine, partly because it is a painless procedure that can be applied without sedation (8), although the current lack of animal studies means that the technique is still relatively unknown. This article provides an insight into the therapy and some practical examples of how it may be used effectively in small animal clinics (Figure 1).
![Argon gas cold plasma](/sites/default/files/images/media/image/Coldplasma_VetFocus_fig1.png)
Figure 1. CAPP therapy using an argon gas cold plasma pen for ulceration of a dog’s pinna. © Christoph Klinger
Basic physical principles and mode of action
Plasma is sometimes called the "fourth state of matter" (after solid, liquid and gas), and is essentially a gaseous mixture of free ions or electrons within a confined space (9). Natural examples of the phenomenon include lightning and solar flares, but plasma can also be produced artificially at room temperature and under normal atmospheric pressure, for example by accelerating charged gaseous particles along an electromagnetic field. CAPP therapy has been shown to positively influence tissue healing by hastening the healing process and reducing scar formation. How it produces its effects is as yet not fully understood, although it is known that CAPP strongly influences certain growth factors (e.g., FGF-7 for keratinocyte migration), anti-inflammatory signaling molecules (e.g., TGF-β) and inflammatory signaling pathways (6, 7, 8, 9, 10, 11).
CAPP was initially reserved for wound disinfection and to promote healing in human burn victims, but is now indicated for use in many other situations. It is effective in treating both simple and complicated skin infections (especially where multi-resistant pathogens are present) as well as for various other wound-healing disorders, such as those that can develop secondary to diabetes (1,3, 6). The therapy is widely reported to be highly effective in combating bacterial, viral and fungal pathogens, even where there is biofilm formation (2, 3, 5, 9), and its physical mode of action means that any resistance to antibiotics, antimycotics or antivirals is irrelevant. Studies have shown that CAPP has an excellent bacteriostatic effect on methicillin-resistant Staphylococcus aureus spp. (MRSA), S. pseudintermedius (MRSP) and multi-resistant Pseudomonas aeruginosa (MRPA), some of the most common bacterial skin pathogens in veterinary medicine (1, 2, 3, 4).
[...]
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