Biomedical application of cold plasma: navigating through plasma types and devices by antimicrobial effectiveness and tissue tolerance

This study compares the biofilm efficacy and tissue compatibility of three cold atmospheric plasma devices: J-Plasma (Apyx Medical), Piezo Brush PZ3 (Reylon Plasma GmbH), and Plasma Care (Terraplasma-Medical GmbH). The focus is on surface temperature, pH shifts, and ROS/RNS production, analyzing their effects on bacterial biofilms and tissue both ex vivo and in vivo. Temperature changes, pH shifts, optical emission spectra, and ROS/RNS levels in the liquid phase are measured. Antimicrobial efficacy is tested against biofilms of Pseudomonas aeruginosa and Staphylococcus aureus, grown on 3D-printed poly(ε-caprolactone) discs and titanium sheets. Tissue tolerability is assessed on porcine skin using direct counting for bactericidal effectiveness and SEM for validation, with histological analysis for tissue effects. Plasma Care demonstrated significant bactericidal capabilities (4 logs against S. aureus in 60 s on PCL), minimal tissue disruption, and required short treatment times, functioning independently of target conductivity. Both J-Plasma and Piezo Brush PZ3 show variable outcomes influenced by treatment duration and target surface conductivity, affecting both bactericidal activity and tissue tolerance. The comparative analysis underscores the importance of selecting plasma devices based on specific clinical needs to enhance biofilm management and minimize tissue damage, supporting tailored applications in precision medicine.