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). We focused on surface temperature, pH shifts, and ROS/RNS production, analyzing their effects on bacterial biofilms and tissue both ex vivo and in vivo. We measured temperature changes, pH shifts, optical emission spectra, and ROS/RNS levels in the liquid phase. Antimicrobial efficacy was tested against biofilms of <i>Pseudomonas aeruginosa</i> and <i>Staphylococcus aureus</i>, grown on 3D-printed poly(ε-caprolactone) discs and titanium sheets. Tissue tolerability was 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 <i>S. aureus</i> in 60 seconds on PCL), minimal tissue disruption, and required short treatment times, functioning independently of target conductivity. Both J-Plasma and Piezo Brush PZ3 showed 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.