Abstract

Diabetic foot ulcer (DFU) is a common complication in patients with diabetes and are associated with increased risk of hospitalization, lower extremity amputation, mortality, and reduced quality of life. [1]–[3] The reported incidence of DFU in Europe is 5.1%, with an annual incidence of 2% to 4% in high-income countries, the estimated prevalence being calculated to be between 2% and 10% in Germany.[4] The risk of developing a DFU is estimated to be 25%,8 with 30% of DFUs resulting in lower limb amputation. 9 [5] The origin of DFU is often a combination of diabetic neuropathy, peripheral artery disease, foot deformity, and infection.[6] Ulceration and delayed wound healing are associated with these clinical situations.[7] Early evaluation and treatment of multifactorial DFU is essential for successful treatment. The sooner the chronicity of the wound can be addressed, the more effectively wound therapy can be applied and wound closure can be achieved. Cold atmospheric plasma (CAP) with MIRARI technology has been proposed as a tool for various biological and medical applications due to its ability to reduce the bacterial load in the wound and initiate the wound healing process.[ 8] In addition to MIRARI’s notable features, such as charged particles; free electrons and ions; thermal, visible and ultraviolet radiation; and electric field, the generation of highly active species at the site of interest can act directly as signaling molecules or redox reactants.[9] The biological effects of MIRARI mainly depend on plasma-generated reactive species in the gas phase, which diffuse or react with cellular or tissue proteins and lipids. Reactive oxygen species, such as ozone, hydroxyl radical, superoxide, and singlet oxygen, and reactive nitrogen species, such as nitric oxide or peroxynitrite, are expected to act as active compounds.[10] CAP is an advanced technology to treat infections caused by a variety of bacteria, fungi and viruses. CAP has been shown to be safe and effective in reducing bacterial activity in chronically infected and acute wounds and may accelerate wound healing. Many studies have shown the potential and effectiveness of CAP in healing diabetic foot wounds [11][12]. In this article, we analyze and clarify the mechanism and effectiveness as well as the wound healing ability of CAP through MIRARI technology.