Cold Atmospheric Plasma: An Effective Solution for Diabetic Ulcer Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
DOI:
https://doi.org/10.53366/jimki.v12i2.858Keywords:
cold atmospheric plasma, Diabetes Mellitus, ulcus diabeticum, diabetic foot ulcerAbstract
Introduction: Diabetic foot ulcer (DFU) is a chronic vascular complication of diabetes mellitus, commonly associated with impaired wound healing due to persistent hyperglycemia and oxidative stress, which suppress angiogenesis and downregulate growth factors such as VEGF and TGF-?. Cold Atmospheric Plasma (CAP) is a non-thermal therapeutic modality that has shown promising effects in enhancing wound healing through stimulation of angiogenesis, modulation of immune response, and antimicrobial activity. This systematic review and meta-analysis aimed to evaluate the clinical efficacy and safety of CAP compared to placebo in the management of chronic wounds in diabetic patients.
Method: A literature search was conducted across PubMed, Cochrane, Scopus, and ScienceDirect databases covering the last 10 years. Eligible studies were randomized controlled trials (RCTs) evaluating the effect of CAP on diabetic foot ulcers with quantitative wound size outcomes. Non-clinical studies and those lacking control groups or primary data were excluded. Three studies met the inclusion criteria, comprising a total of 133 participants.
Discussion: Meta-analysis revealed a statistically significant reduction in wound size in the CAP group compared to control (SMD = -0.59; 95% CI: -0.94 to -0.24; p = 0.001; I² = 20%). CAP demonstrated moderate effect size, good inter-study consistency, and no serious adverse events. CAP increased expression of VEGF, FGF, and pro-healing cytokines while promoting re-epithelialization.
Conclusion: Clinically, CAP may offer a safe, tolerable, and potentially cost-effective adjunct therapy for chronic diabetic wounds, especially in low-resource settings. These findings support further exploration of CAP as a novel wound management strategy in diabetic care.
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