Diabetic foot ulcers (DFUs) remain one of the most severe and costly complications of diabetes, often leading to prolonged morbidity, infection, hospitalisation, and even amputation. In a 2023 study published in the Journal of Wound Care, Chilgar and Andurkar evaluated the effectiveness of spatially modulated Er:YAG laser therapy in the treatment of hard-to-heal diabetic ulcers .
This single-arm clinical study investigated whether combining laser debridement with deep tissue biostimulation could achieve complete wound closure without surgical intervention.
Study Overview
Patients were included if they had hard-to-heal diabetic ulcers and were willing to continue treatment until full healing occurred. Ulcers were classified according to Wagner grading.
Patient Characteristics
Most ulcers (69.5%) had a surface area ≤25 cm² .
Treatment Protocol: Two-Step Er:YAG + RecoSMA Approach
All patients underwent a standardized two-step protocol weekly until healing.
🔹 Step 1 – High-Power Er:YAG Laser Ablation (Debridement)
This stage removed necrotic tissue and biofilm via rapid tissue vaporisation (>300°C), without causing thermal damage to surrounding viable tissue. The procedure was performed in an outpatient setting without the need for anaesthesia.
🔹 Step 2 – RecoSMA Biostimulation
RecoSMA technology divides laser energy into multiple microbeams, producing mechanical microdestruction and acoustic resonance in deeper tissues. This re-triggers the inflammatory phase of healing, stimulates neovascularisation, enhances collagen synthesis, and promotes extracellular matrix remodelling.
Standard Wound Care
In addition to laser therapy, patients received:
Results
1️⃣ Complete Healing Achieved in All Patients
All 59 diabetic ulcers healed completely by the end of treatment.
This represents a 100% closure rate within the treated cohort .
2️⃣ Factors Influencing Number of Sessions
Statistically significant factors associated with needing more sessions:
Smaller wounds achieved closure more rapidly.
3️⃣ Long-Term Follow-Up
This suggests durable healing and sustained tissue regeneration.
Mechanism of Action
The study highlights a synergistic dual mechanism:
The authors describe this as a “holistic solution” combining wound cleansing and activation of endogenous healing pathways .
Clinical Implications
This study suggests that spatially modulated Er:YAG laser therapy:
Given the high amputation risk associated with diabetic ulcers, these findings are clinically significant.
Limitations
The authors acknowledge:
Further multicentre controlled studies are recommended.
Conclusion
In this prospective clinical study, spatially modulated Er:YAG laser therapy achieved complete wound closure in all 59 hard-to-heal diabetic ulcers with an average of 4.4 treatment sessions. The two-step protocol combining laser ablation and RecoSMA biostimulation appears to offer a promising, non-surgical approach to diabetic foot ulcer management.
Source:
Chilgar RM, Andurkar SP. Spatially modulated erbium YAG laser as a treatment for diabetic ulcer. Journal of Wound Care. 2023;32(Silk Road Supplement):S21–S29 .
If you’d like, I can now:
This single-arm clinical study investigated whether combining laser debridement with deep tissue biostimulation could achieve complete wound closure without surgical intervention.
Study Overview
- Design: Prospective single-arm clinical study
- Setting: Plastic Surgery Department, Elrevo Clinic, India
- Study period: November 2017 – April 2023
- Sample size: 59 patients with diabetic ulcers
- Primary endpoint: Complete wound closure
- Secondary endpoints: Time to closure, number of laser sessions
Patients were included if they had hard-to-heal diabetic ulcers and were willing to continue treatment until full healing occurred. Ulcers were classified according to Wagner grading.
Patient Characteristics
- Mean wound surface area at baseline: 25.7 cm² (median 12 cm²)
- Average ulcer duration: 34 weeks
- Most common location: Right plantar forefoot (27.1%)
- Comorbidities:
- 39% had hypertension
- 81% had diabetes for 1–10 years
- Mean blood glucose level: 236 mg/dl
Most ulcers (69.5%) had a surface area ≤25 cm² .
Treatment Protocol: Two-Step Er:YAG + RecoSMA Approach
All patients underwent a standardized two-step protocol weekly until healing.
🔹 Step 1 – High-Power Er:YAG Laser Ablation (Debridement)
- Wavelength: 2940 nm
- Frequency: 3 Hz
- Energy density: 15.9 J/cm²
- 4 mm laser tip
- Non-contact technique
- Endpoint: capillary bleeding
This stage removed necrotic tissue and biofilm via rapid tissue vaporisation (>300°C), without causing thermal damage to surrounding viable tissue. The procedure was performed in an outpatient setting without the need for anaesthesia.
🔹 Step 2 – RecoSMA Biostimulation
- Frequency: 3 Hz
- Energy density: 2.30 J/cm²
- Contact application
- Treatment of wound bed, edges, and 3 cm periphery
RecoSMA technology divides laser energy into multiple microbeams, producing mechanical microdestruction and acoustic resonance in deeper tissues. This re-triggers the inflammatory phase of healing, stimulates neovascularisation, enhances collagen synthesis, and promotes extracellular matrix remodelling.
Standard Wound Care
In addition to laser therapy, patients received:
- Alternate-day dressing changes
- Topical antiseptics
- Oral antibiotics when indicated (62.7%)
- Offloading for plantar ulcers
- Clinical photographic documentation during each session
Results
1️⃣ Complete Healing Achieved in All Patients
All 59 diabetic ulcers healed completely by the end of treatment.
- Average number of sessions: 4.41 (range 1–11)
- Majority (69.5%) required ≤5 sessions
- Wound size reduced progressively with each treatment
This represents a 100% closure rate within the treated cohort .
2️⃣ Factors Influencing Number of Sessions
Statistically significant factors associated with needing more sessions:
- Initial wound surface area >25 cm² (p=0.001)
- Presence of oedema (p=0.007)
- Hypertension (p=0.027)
Smaller wounds achieved closure more rapidly.
3️⃣ Long-Term Follow-Up
- Follow-up range: 4–70 months
- Average follow-up: ~23 months
- Recurrence rate: 0% at the same site
This suggests durable healing and sustained tissue regeneration.
Mechanism of Action
The study highlights a synergistic dual mechanism:
- Laser Ablation
- Precise removal of necrotic tissue and biofilm
- Reduced microbial burden
- Minimal collateral damage
- RecoSMA Biostimulation
- Mechanical cavitation effect in deeper tissue
- Reactivation of inflammatory cascade
- Stimulation of fibroblast proliferation
- Enhanced collagen and ECM formation
The authors describe this as a “holistic solution” combining wound cleansing and activation of endogenous healing pathways .
Clinical Implications
This study suggests that spatially modulated Er:YAG laser therapy:
- Can achieve complete closure of diabetic ulcers up to 25 cm² without surgery
- May reduce need for operating theatre-based sharp debridement
- Provides outpatient, minimally invasive treatment
- Demonstrates long-term durability of healing
Given the high amputation risk associated with diabetic ulcers, these findings are clinically significant.
Limitations
The authors acknowledge:
- Single-arm design (no control group)
- Moderate sample size
- Potential variability in wound measurement
- No histological confirmation of regenerated tissue
- Limited generalisability
Further multicentre controlled studies are recommended.
Conclusion
In this prospective clinical study, spatially modulated Er:YAG laser therapy achieved complete wound closure in all 59 hard-to-heal diabetic ulcers with an average of 4.4 treatment sessions. The two-step protocol combining laser ablation and RecoSMA biostimulation appears to offer a promising, non-surgical approach to diabetic foot ulcer management.
Source:
Chilgar RM, Andurkar SP. Spatially modulated erbium YAG laser as a treatment for diabetic ulcer. Journal of Wound Care. 2023;32(Silk Road Supplement):S21–S29 .
If you’d like, I can now:
- Create a clinician-focused version
- Rewrite this in a more commercial / website marketing tone
- Prepare a side-by-side comparison summary of both studies
- Develop a LinkedIn article version