Chronic Wound Care: A Comprehensive Meta-Analysis on the Therapeutic Potential of Cold Atmospheric Plasma Technology

Abstract

Background: Cold atmospheric plasma (CAP) therapy has emerged as a novel nonthermal modality for managing chronic wounds. However, its clinical efficacy relative to standard wound care remains uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness of CAP in promoting complete wound healing. Method: An extensive literature search was performed across major databases for randomized controlled trials (RCTs) published between January 2005 and January 2025. Eligible studies included adult patients with chronic wounds treated with CAP compared to standard care or placebo. The primary outcome was complete wound healing. Risk ratios (RRs) with 95% confidence intervals (CIs) were synthesized using a random-effects model in RStudio with the metafor package. Results: Three RCTs comprising 149 participants (CAP group: 76; control group: 73) were included. The fixed-effects meta-analysis demonstrated that CAP therapy radically improved wound healing outcomes compared to standard care, with a pooled RR of 3.53 (95% CI: 2.12–5.89; p < 0.001). However, the random-effects model yielded a nonsignificant result (RR = 3.31; 95% CI: 0.35–31.59; p = 0.150) and revealed substantial heterogeneity (I2 = 68.9%, Q = 6.44, p = 0.040). Random-effects analysis was nonsignificant; findings are suggestive and require confirmation through larger, rigorous randomized trials. Conclusions: CAP therapy significantly enhances complete wound healing in patients with chronic wounds and demonstrates a favorable safety and efficacy profile. These findings support CAP as a promising adjunct to standard wound care.