Cold atmospheric plasma accelerates wound closure and reduces pathogenic bacterial load in diabetic foot ulcers: a randomized controlled trial

Diabetic foot ulcers (DFUs) are a serious and common complication of diabetes, affecting up to 25% of patients and often leading to infection, amputation, and increased mortality. The growing prevalence of antibiotic resistance in DFUs underscores the urgent need for alternative therapies. Cold atmospheric plasma (CAP) has emerged as a non-antibiotic intervention with promising antibacterial and wound healing properties. This study evaluated the effectiveness of helium-based CAP therapy in enhancing wound healing and reducing bacterial load in DFUs, focusing on key pathogenic bacteria. In this open-label, randomized controlled trial, 50 patients with Wagner grade 2 DFUs were assigned to receive either standard care alone or standard care plus CAP treatment. CAP was applied twice weekly for three weeks (30 s/cm²). Wound size and bacterial load were measured at baseline (before plasma treatment) and on days 7, 14, and 21 (after plasma treatment). Quantitative bacterial cultures targeted S. aureus, P. aeruginosa, E. coli, and E. cloacae. Both groups showed significant reductions in wound size and bacterial load over the study period. However, the CAP group demonstrated significantly greater wound contraction (1.21 cm/day vs. 0.79 cm/day) and a higher reduction in bacterial load (32.8% vs. 10.0%) compared to the control group. CAP significantly decreased the counts of all four targeted bacterial species, highlighting its broad-spectrum antimicrobial effect. CAP therapy significantly accelerated wound healing and reduced the bacterial burden in patients with diabetic foot ulcers, including key resistant pathogens. These findings support the potential of CAP as an effective non-chemical adjunctive therapy in DFU management. Further research is warranted to optimize treatment parameters and assess long-term outcomes.