Fabricius Christian, Tezer Irem

1. Christian FABRICIUS, M.D., Ph.D
GTC Life Science
Gamlestadsvägen 2-4
S-415 02 Göteborg, Sweden
Irem TEZER, M.D.
Hiperox Wound and Hyperbaric Center
Demirci Kara Mah. Avni Tolunay Cad. No: 46/1
07100 Antalya, Turkey
CHRONIC NON-HEALING WOUND
MANAGEMENT WITH PLASMA TECHNOLOGY

2. • High temperature, low density
argon plasma
• Thermal energy – for coagulation
& vaporization
• Kinetic energy – for cutting &
fluid dispersal
• Controllable, visible effect
• Proprietary technology for rapid
generation of high energy Argon
Plasma
• High temperature
• Low thermal density
CHRONIC NON-HEALING WOUND MANAGEMENT WITH
PLASMA TECHNOLOGY
Thermal and non-thermal plasma
Introduction
• Chronic wounds demand an aggressive,
multifactorial approach. Repetitive surgical
debridement, revascularization, when necessary,
antibiotics and dressings form the foundation of
therapy. However, once the wound is clean and
well vascularized, they still may not progress to
healing. Several adjuvant treatment methods
have been developed to further stimulate healing
and non-thermal plasma seems to be one of
them.
Thermal and Non-thermal plasma
• Plasmas have been used for a long time for
sterilization of medical equipment, packaging in
the food industry, implants, blood coagulation,
etc. This is partly due to their high bactericidal
effectiveness and partly due to their easy access
into narrow and confined spaces. Thermal and
non-thermal (i.e. cold) plasmas – both already
widely established in medicine – are used for
various therapeutic applications. Particularly in
dermatology, plasma applications hold big
potential, for example, in wound healing, such as
efficient disinfection or sterilization, therapy of
various skin infections or tissue regeneration. It
has recently been demonstrated that non-
thermal atmospheric pressure plasma (less than
40 ◦C at the point of application) can be applied
directly to living cells and tissues, killing bacteria
and inducing blood coagulation without
significant heating. Non-thermal plasma
treatment has also been shown to promote cell
proliferation, enhance cell transfection, sterilize
root canals and possibly increase wound healing.
The simplicity and flexibility of devices required
to generate non-thermal plasma and apply it to
tissues is particularly appealing. However, an
understanding of mechanisms by which non-
thermal plasma interacts with living cells and
tissues is required to fully develop its clinical
applications.
Medical plasma for wound healing
• It is reported that direct plasma in contact with
tissue leads to a significantly faster bacteria
inactivation on this tissue due to the presence of
charges. Direct plasma treatment are able to
sterilize and also responsible for many interesting
biological effects; e.g. effect of NO in tissue
regeneration. Optimal NO activity is required for
the full expression and receptor upregulation of
VEGF and PDGF. A deficiency in NO bioactivity is
associated with diabetes-impaired wound healing
. Experimentally and clinically it is validated that
plasmadynamic therapy increases nitric oxide on
wounds and sterilizing the bacteria that helps
wound healing.

3. CHRONIC NON-HEALING WOUND MANAGEMENT WITH
PLASMA TECHNOLOGY
Continuous and distance effects
Vaporization
Energy is focused more than with
coagulation
• Smaller area = higher energy
density
• Vaporization of Rapid Dry Layer
• Progression of thermal diffusion
Cutting with Coagulation
• Energy is tightly focused
• Rapid vaporization takes place
over small area
• Lateral Coagulation occurs with
latent thermal diffusion
The argon plasma is short-lived, and gives up
its energy readily in three useful forms:
• As UV light – in the visible and near ultraviolet
parts of the spectrum, which helpfully illuminates
the field, but is not sufficiently intense to cause
damage or require any eye-protection, antibacterial
wave lenght
• As thermal energy – sufficient to heat the tissue to
a very limited depth and cause coagulation of the
surface bleeding
• In the form of kinetic energy – that clears any
biofilm layer of the bacterias from the surface of the
tissue

4. CHRONIC NON-HEALING WOUND MANAGEMENT WITH
PLASMA TECHNOLOGY
Clinical test

5. Literature Cited
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L Zimmermann
Kalghatgi S, Kelly CM, Cerchar E, Torabi B, Alekseev O, et al. (2011) Effects of Non-Thermal Plasma on
Mammalian Cells. PLoS ONE 6(1): e16270. doi:10.1371/journal.pone.0016270
Plasma applications in medicine with a special focus on dermatology. J Heinlin1,†, G Isbary2,†, W Stolz2, G
Morfill3, M Landthaler1, T Shimizu3, B Steffes3, T Nosenko3, JL Zimmermann3 andS Karrer1,* Journal of the
European Academy of Dermatology and Venereology Volume 25, Issue 1, pages 1–11, January 2011
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J. Phys. 11 115020
Fridman G, Shekhter A B, Vasilets V N, Friedman G, Gutsol A and Fridman A 2008 Applied plasma medicine
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Shekhter A B, Serezhenkov V A, Rudenko T G, Pekshev A V and Vanin A F 2005 Beneficial effect of gaseousnitric
oxide on the healing of skin wounds Nitric Oxide-Biol. Chem. 12 210–9
Fukumura D, Gohongi R, Kadambi A, et al. Predominant role of endothelial nitric oxide synthase in vascular
endothelial growth factor-induced angiogenesis and vascular permeability. Proc Natl Acad Sci USA.
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nitric oxide synthesis: a possible pathophysiologic correlation. Surgery. 1997;121:513–9
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plasmadynamic therapy of wounds with nitric oxide Bull. Exp. Biol. Med. 126 829–34
Sonoda Y, Olvera N, Chi DS, Brown CL, Abu-Rustum NR, Levine DA. Pathologic analysis of ex vivo plasma energy
tumor destruction in patients with ovarian or peritoneal cancer. Int J Gynecol Cancer. 2010; 20:1326-30
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Thermal plasma is a surgically proven new technique for cutting, ablating, coagulating
and drying. In a comparison with traditional wound care it can be used to:
- illuminate the wound area
- coagulate
- clear the wound area from fluids
- create a flexible sealing layer in the wound area
It is thus suitable for infection control as well as debridement. Any side effects of this new
technology is expected to be minimal since the thermal spread is minimized, thus
ensuring delicated precision, still preserving the underlying tissues.
CHRONIC NON-HEALING WOUND MANAGEMENT WITH
PLASMA TECHNOLOGY
Summary